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Apr 10 13 10:37a %.01 p. 1 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205-6232 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sia y.or ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspt:ction 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 lop of this form with n 35 days of receipt of the <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 certification and retu ned 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 t oted dates will be billed at <br /> the current hourly rate ($125). <br /> For this certification to be complete the operator of the site„ust include: <br /> • A statement documenting what corrective actions were taken or will b.- taken for each violation <br /> • Copies of sample results/manifests/training records/other appropriate;taperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: a) °2S 12013 Inspected By:_Th Uq TkAd <br /> Facility Address: 37755 P' ydgC� BLS' EPA ID#: W 000 /ZS b05` <br /> I certify under penalty of law that: <br /> I. I have corrected the violations specified in the Inspection Report from lie above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and 1 believe the information to be true, accurate. and complete: <br /> ✓ Photos ✓ Paperwork ✓Staten ent <br /> 3. I am authorized to submit this certification on behalf of the Responden . <br /> 4. I am aware that there are significant penalties for submitting false infor nation, including the <br /> possibility of a tine and/or imprisonment for known violations. (HSC 2 i 191) <br /> Name:_ NAA1,10t GLALfi I)2 Title: C MPJ)Ck �AdzDl Af <br /> Signature: Date: 311�/2 013 <br /> EHD 22-02-005 Rev 10-07 <br />