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pprt.liiutt «R R 19012 <br /> SAN JOAQutN COUNTY <br /> ENVIRONMENTAL HEAi TH DEPARTMENT <br /> 600 E.Main St.,Stockton,CA 93202-3029 <br /> Te[ephofe:(209)468-3420 Fax:(209)468-3433 Web: ,sieov 0•Jehd <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 rile <br /> Inspection Report. <br /> All corrections to other violations noted in the attached Inspection Report or Continuation Form,or <br /> disputes to any violations,are to be submitted using this cerWication 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 billed at <br /> the current hourly rate (S1267), <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/othcr appropriate paperwork,and/or photos <br /> verifyin.-corrections <br /> • Operator's certification <br /> Inspection Date: 2I3� 12 Inspected By: 7�Qj! a Tur�� <br /> Facility Address_ 31 15 P I. Tlgr"1"ci EPA. ID#:fAyp nrn �- <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specificd 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 /> 4. 1 am aware that there are significant penalties for submitting false information,including die <br /> possibility of a fine and/or imprisonment for known violations_ (HSC 25191) <br /> Name: vi re�.V�l t b. S Title:US l �°nYvi21�l. /1 .r�wady <br /> Signature_ J�� <br /> EHD 22-02-005 Rev 08/10 <br /> �''� ' Vid 4020 I�� d10Z-�0-983 <br />