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%woe SAN JOAQUIN COUNTY %woe <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sieov.or¢/e6d <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)address at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> Alf corrections to other violations noted in the attached Inspection Report(IR)or Continuation Form,or <br /> disputes to any vio ahons, aze to a submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. <br /> Note: Alt EHD staff time associated with failing to comply by the above noted <br /> tdates will be billed at <br /> he current hourly rate($122). <br /> FOI II11S Celrtif Cat10ri t0 b0 COri1�10t0 the operator of the site must include: <br /> • A statement documenting what corrective actions were taken or will Ue taken for each violation <br /> • Copies of sample results/manifests/training records/other appropriate <br /> g coions paperwork, and/or photos <br /> venfyinrrect <br /> • Operator's certification <br /> Inspection Date: September 15, 2010 Inspected By: Garrett Backus <br /> Facility Address: 3282 Auto Center Circle EPA ID#: CAD981976228 <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. I have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and Ibelieve the information to be true,accurate,and complete: <br /> ,/"Photo, 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. (HSC 25191) (� <br /> Name:, ��he \ -;t�jlY , S Title:&r_ U"rP t't`{�I etnf <br /> Signature: Date: 1611 o <br /> EHD 22-02-005 Rev 08/10 <br />