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07/108/2006 12:09 <br />4622752 <br />USA110 <br />M <br />III 1 � i�� �i it li 4r�i �i 1110. I lqiII I <br />SAN JOAQVIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, P Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Far: (209) 4683433 Web: www.U&ovor ehd <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 />All corrections to other violationsnoted 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 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 />venfrring corrections <br />• Operator's certification <br />Inspection Date: (0/ o�, <br />34 Haripz�W- Rd. <br />Facility Address: ,4,, )Q n <br />I certify under penalty of law that: <br />Inspected By: ! �� <br />EPA ID#Q4'R ©O() Pa 04 <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. I am authorized to submit this certification on behalf of the Respondent. <br />a. I am aware that there are significant penalties for submitting false information, including the <br />.,r,00+h�l�r., nf'o fi"� �r,�l..r +mnricnnmrnt fnr lnnwn vinlafinna INCL' 751411 <br />