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SAN jOAQUTN COUN'T'Y <br />ENVIRONMENTAL HEALTH DEPAR'T'MENT <br />600 East Main Street, stockton, CA 95202-3029 <br />209 468-3433 Web: www.s' ov.or fihd <br />Telephone: (209) 468-3420 Fax: ( ) - �•� <br />ZU] <br />RETURN TO COMPLIANCE CERTIFICATION...; <br />OR violations noted in the "Notice to Comply" in the attached Inspection Report must be ��t:�G=NT <br />Any MIN--� <br />corrected within 30 dans of receipt of this inspection. , This o �s form within 35 days oreceipt O the <br />Environmental Health Department (EHD} address p <br />Inspection Report. rt IR or Continuation Form, or <br />Al] corrections to other violationsroted in the attached Inspection <br />and returned to EHD wi m 30 s <br />disputes to amy v10 attons, are to be submitted using the shave noted dates will be bided at <br />unless otherwise specified in the Inspection Report. <br />Note: All EHD staff time associated with failing to comply by <br />the current hourly rate (S122). <br />For 11S certification <br />ontitog heat C01� pleaeitheons operator <br />of heor site <br />m st include: <br />taken ud each violation <br />• A statement dvcum records/other appropriate paperwork, and/or photos <br />• Copies of sample results7manifests/training <br />verifying corrections <br />• operator's certification <br />Inspection Date: <br />January 24, 2011 Inspected 8y: Garrett Backus <br />10858 N Hwy 99 EPA 1D#. CAL000291039 <br />Facility Address: � <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 />2, I have personally examined the following documentation submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information 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 1 am 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 />Title: ' <br />Name. ++ <br />Date: l 1 n N <br />EHD 22-02-005 Rev 08/10 <br />T•d 22t7289t:01 8299T26608T pMD3H9 00UJOWW06J SZ:ST TT02-LT-88J <br />