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06/01/2007 FRI 13: 34 FAX 2094683433 SIC EHD 0004/004 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`4 Floor,Stockton,CA 95202.2708 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sj ov.or <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 PM)address at the top of this form within 35 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 60 days <br /> unless otherwise specified in the IR ` <br /> For this Certification t0 be COffiplete.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 bate: 0;/nl 07 Inspected By: l ZUJOL <br /> Facility Address: ao 6tnnoch I ane EPA EN: <br /> 7. <br /> I certify underpenalty 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 true,accurate,and complete: <br /> Photos - Paperwork Statement <br /> 3. I 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: liwxa Atwbt,%amulaxevo Tide: NSE Speu uQi At <br /> Signature: Ral4"gobolvo- Sp,- Date: 06(0410-7 <br /> CVTWC0lx. <br /> 11` T X1 An AAG n..-. In AA <br />