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04/17/2008 14:21 503524iAM RUTH HA - HP • PAGE 06/06 <br /> couo «:na /0`J4 5w 096x0 PAVE 01/01 <br /> SAN J4490ti(j'QUNT r <br /> FNvtRotTtSY*.ff?ALTI(nsPARTMPNT <br /> 600 Easy Main sttpa" io4#4,CA 95202.3029 <br /> Telephone:(209)468342, Fax!' 21;1'40VI3433 Wab:MMK jgev,or¢/e 4 <br /> RETURN TO COIViiI?' CERTIFICATION <br /> Any-MOZ violations noted in the"Notice to QgtI}j?l P jz the attached Inspection Report must be <br /> corrected within 30,days of receipt of this inspecp fit, `I�hm certification form must be submitted t0 the <br /> Environmental health Department(EHD)addre 6 Fh'eTop <br /> of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All corrections to other violations noted in the att118hed Inspection Report(IR)or Continuation Form,or ' <br /> disputes to any violations,are to be submitted us° ' ;this#p" 1ification and returned to EHD within!30 days . <br /> unless otherwise specified in the Inspection Repq <br /> A <br /> Note; All ER1D stall•time associated with M4 to cq pply by the above noted dates will be billed at <br /> the current hourly rate($98). <br /> For this certification to be COTi'it7 ,pt the operator of the site must include: <br /> • A statement documenting what correctl titins were taken or will be taken for each violation <br /> • Copies of sample results/manifests/trai4g rzrords/other appropriate paperwork, and/or photos <br /> ven6ing corrections <br /> • Operator's cettification <br /> Inspection Dater/2to Illy inspected 13y: h41� a-4 -"E- <br /> Facility <br /> -Facility Address: /2a� Gv EP,A.ID#:.C' 80 /0 6 <br /> I certify under penalty of law that: <br /> 1. i have corrected the violations specified in tha Inspeotion Report from the above-mentioned, <br /> inspection date. <br /> 2. 1 have personally examined the foliowitj ,dpF})rtlFlrtation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the iRf 'tMatiop to be tore,accurate, and Complete; <br /> Photos Pq ,prwork Statemcnt <br /> 3, 1 am authorized to submit this certificatipp gu 1!P alf of the Respondent. <br /> 4. 1 am aware that there are significant petagl#w for.submitting false information, including the <br /> possibility of a fine and/or impnsonmerj kriclv/n violations, (H5C 25191)' <br /> Name; l Title: A4 //?0iGe <br /> Signature: J)ate: <br /> Fun 9747-005 Rev 11/07 <br />