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SAN JOAQUIN COUNTY , <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Mein Street. Stockton, CA 96202-3029 <br /> Telephone:(209)468.3420 Fix:(209)468-3433 Web:www,sigoy,Qj{/. <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached'fnspection Report must be <br /> corrected A thln 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EMD)address at the top of this form within 30 days of receipt of the <br /> Inspection Report <br /> All corrections to other violations noted In the attached Inspection Report (IR)or Continuation Form,or <br /> disputes to arty violations,are to be submitted using this certification and returned to EHD within 30 dans <br /> unless otherwise specified In the Inspection Report. <br /> NOW All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate of$103 (beginning 611109 the hourly rate will be$115). <br /> For this certification t0 be complete the operator of the site must Inciude: - <br /> • A statement documenting what corrective actions were taken or will be taken for:each violation <br /> . Copies of sample results/manffestsltralning recordslother appropriate paperwork, and/or photW <br /> verifying corrections <br /> a Operator's certificatlon - <br /> Inspection Date: y�� 9 Inspected By: <br /> Facility Address: 3Z1 e . w, 4"1,6;e1& EPA ID*: <br /> I certify under penalty of law that <br /> I 1 1 have corrected the violations specified fn 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 bellave the Information to be true,accurate, and complete: <br /> Photos_ K Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent <br /> 4 1 am aware that there are signs fcant penalties for submitting false Information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: �6%nIJ 3eW, Title: <br /> Signature: .�L Date: <br /> 0T elty yra.. a9 <br /> f/in �arfj. /Gn�C!*cJfii� <br /> Rem Fir �i/Ta <br /> e4o2202 Wra.00 ,3 ,�,•/..al,�.lfxOr'!. It T4" /W. <br />