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1112612008 14 :35 FAX 10021007 <br /> SAN JOAQUIN COUN'T'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 Ea8t Main Street,Stockton,CA 95202-3029 <br /> Telephone.(209)468-3420 Fox.(209)468-3433 Web:www.sigov.orglchd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MIN R violations noted in the"Notice to Comply" in the attached Inspection Report must be <br /> corrected within 3Q days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EHD) address at the top of this form within :15 days of receipt of the <br /> Inspection Report. <br /> All coMoons 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 BHI)within 30 das <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 billed at <br /> the current hourly rate. <br /> For this certification to be complete the operator of the site,must include: <br /> • A statement documenting what corrective actions were taken or will be taken for each violation <br /> • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operators cmfificatlon <br /> Inspection Date: ' Inspected By: <br /> Facility Address: G EPA ID#/�i� <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the fallowing documentation submitted'as proof of compliance FOR <br /> EACH VIOLATION and I believe the inform tion to be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations, (HS <br /> .0 2519 1) <br /> Dame- if <br /> Signature: <br />