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• i SAN JOAQUINCOUNTY ENVIRONMENTAI,HEALTH DEPARTMENT 304 East Weber-Avewe,T'Floor,6tochoq,CA 95202-2708 Telephone:(209)468-3420 Paz:(209)468.3433 Web.,www.sjgov.orgJehd RETURN TO COMPLIANCE CERTIFICATION Any MINOR violattcris noted in the"Notice.to Comply"in the attached inspection report must be corrected within 30 days of receipt of this imp�c4ag%TNs certification fdrrrt must be submitted.to trio Environmental Health Department.(ERR)addfess-at the top of this form vrithin 35 days of receipt of the inspection report. All corrections to other violations noted in the attached Inspection Report 4IR)or Cbritimiation Form,or disputes to any violations,are to be submitted using this certification and returned to hHD within 60 days unless otherwise specified in the IR: For this certification to be complete the Ioperator of the site must include: • A statement documenting what:corrective,actions were taken or will be taken for each violation • Copies of sample resultshnanifests/training records/other appropriate paperwork, and/or photos verifying corrections • Operator's certification Inspection Date: / o/i cP A�,Co Inspected By: R AV VOnv F[, u E Facility Address: 3.51S "Ay Y DA I VC EPA`ID#: L?A D 00 0(0 315t�7 I certify under penalty of law that: . . 1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 2. I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate,and complete: - Photos ✓ Paperwork Statement 3. I am authorized to submit this-certification on behalf of the Respondent. 4. lam aware that there are significant penalties for submitting false information,including the possibility of a fine and/or imprisonment for known violations.(HSC 25191) Name: l/lO,!na✓ /+V ,�iev7e- ' Title: /�W /r/r a.r�yon Signature: Date: EHD 22-02-005 Rev 12-04