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002454 <br />SAN JOAQUIN COUNTY <br />ENVIRONMEWAL HEAD! b6FARTMENT <br />600 East Allain Street, Stockton, CA 95202-362.9 <br />Telep``one: (209) 45$3420 Fax: (249) 468-3433 Web: www.sigov.orq/ehd <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the °Notice to Comply" in the attached Inspection Report must be <br />corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br />Environmental Health Department (EHD) addrass at the top of this farm within 30 days of receipt of the <br />Inspection Report. <br />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification and returned to EHD within _30 days <br />unless otherwise specified in the Inspection Report. <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be <br />billed at the current hourly rate. <br />For this Certification to be COmpiete the operator of the site must include: <br />P A statement documenting what corrective actions were taken or will be taken for each violation <br />• Copies of sample resultslmanifests/training records/other appropriate paperwork, and/or photos <br />verifying corrections <br />Inspection Date: c5` 12-6.-a ._... _--..---.-.-.... Inspected By: C <br />1 Alqq. � 7%7�ro�-,� ,,fin l! ca I Q 1 51-7 <br />Facility Address: ��A `i t'2�� EPA ID# <br />I certify under penalty of law that: <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />_I have personally examined the following documentation submitted as proof of compliance FOR <br />EACN-VIOLATION-and ri)elieve the ', inforrhation- to b�_, true, accurate,.andcomplotrL_ <br />Photos Paperwork Statement <br />3. 1 am authorized to submit this certification an behalf of the Respondent. <br />4 lam aware that there are significant penalties for submitting false information, including the <br />possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />Name:raN��� Title:YS/� % <br />Date. ,i j �J & , <br />LHU 22 -M -WO PLOY W06 <br />