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SAN JOAQUIN COUNTY <br /> ENv1RC)NN1t:;N't'AL Hi;AL Hi DEYARTMEN`r <br /> 304 East We1wr Avcnuc, Yd Floor. Stockton.("'A 95202-2708 <br /> Telephone:(204)468,3420 Fax. (209)469.3433 Web: www,sjf30v.or9/c1l0 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the `Notice to C'(.)mply" in the attached inspection rcport rrlust he <br /> corrected within,30 days of rccc;ipt of this inspection. ']"his certification Harm must be submitted to the <br /> Environrncntal Health Department (EDIT)) address at the top of this fore, within 35 days of'roccipt ofthe <br /> inspection report. <br /> All corrections to other violations noted in the attached Ii spc ction Report (iR) or Continuation Form, or <br /> disputes- --- <br /> I....... to anon y violations, are to be submitted using this certification and returned toE;I- D within fi() cis <br /> unless ollm-wise specificd in the IR. <br /> For this certification. to be complete the operator of the site rust include: <br /> • A statement documenting what corrective actions were taken or will be taken for each violation <br /> • C"ople; of'sample results/manif csts/i.raininb records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • ()pc:t'atirr"ti ��iiili�-:i�i�,Ai <br /> ..,..._......... <br /> i <br /> �y i <br /> Inspected By�llyj_�_L".�- Le.__ <br /> i <br /> Facility Address:. U50 S .uAs ;��a EPA I.l)# LCao g 1y���5S ...____ � <br /> I certify under penalty of law that: <br /> i <br /> 1. i have corrected the violations specified in the inspection Report firom the above-rncritioned <br /> inspection date. <br /> 2. l have personally examined the following documentation submitted as proof of compliance FOR <br /> F..,ACH VIOLATION and .I believe the infornation to be true, accurate, and complete: <br /> Photos Paperwork _ Statement <br /> 3, 1 all, authorized to submit this certification on behalf'of tilt; Respondent. <br /> 4. 1 gun aware that there: are significant penalties for submitting false information, including;the <br /> possibility of a fine and/or imprisonment for known violations. (HSC." 251 e)1) <br /> ` <br /> Name ,......� _ � _. e: <br /> Date. <br /> , a ✓f �1 <br /> T7�►te: <br /> Stgnaturc .� <br /> EIHD 22-02-005 Rev 12,04 <br />