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Nov 10 10 11:22a p,1 <br /> SAN JOAQUIN COUNTY <br /> EmraoNMENTAL HEALTIi DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3029 <br /> NOV <br /> Telepkone:(209)468-3420 Fax: w(209)468-3433 Web: .sjgov.crg� 10 2010 <br /> OUNTY <br /> TAL <br /> RETURN TO COMPLIANCE CEKFIi+ICATION "Evtrrt�?j-:3TMENT <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 /> Ins ection Report. <br /> Allcorrectionsto other violations noted in the attached Inspection Report(IR)or Continuation Form,or <br /> di��ppntec to aay vso ahonc; are to a submitted using thin certification and rehnned to EHLI within it)love <br /> ttnless otherwise specified in the Inspection Report. <br /> Note: All EHD staff time assonated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate($I22). <br /> FO <br /> i 115 CCI C1fICltlOri t0 �J0 COII1�i0te the operator of the site must include: <br /> • A statenicut docun�cuting what wncctrve nctiona were taken or will be tnkcn for Inch violntion <br /> • Copies of sample results/manif ests/training records/other appropriate paperwork and(or photos <br /> venfytng corrections <br /> • Operator's certification <br /> Inspection Date: Z� 0 Inspectedfly: <br /> gra ��� C-L, m .5 1)) Z <br /> Facility Address: EPA ID#: <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 I believe the information to be hue,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 /> possibili a fine and/or i�sonment for known violations. (HSC 25191) <br /> Name: <br /> Signature: , ' Date: <br /> EHD 22-02-005 Rev 08/10 J <br />