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SAN JOAQUIN COUNTY ,y <br /> ENVIRONMENTAL HEALTH DEPARTMENT t , <br /> 600 East Main Street, Stockton, CA 95202-3029 ?� <br /> Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.sioov.ora/ehdCEP I <br /> 4 2009 <br /> RETURN TO COMPLIANCE CERTIFICAT161W ENT <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 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 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 /> • Operator's certification <br /> Inspection Date: .8111 /09 Inspected By: (kr, S Ca ps } <br /> y� <br /> Facility Address: Cocke_-Go� L4 , c4 2.5'23 7- EPA ID#: ( q¢;I K y qo,5-! <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 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 /> Name: ,S Title: Ptah- /qc a coo e/- <br /> Signature: Date: <br /> Cl!!1 DO 119.(VIS Wev ONI(1H <br />