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�qa ►�`"� <br /> SAN JOAQUIN COUNTY r '�e'� 4- l� <br /> UUU II�IILLL��� LLL��� 11 L� ENVIRONMENTAL HEALTH DEPARTMENT V JJ <br /> JUL p 2 2010 600 East Main Street, Stockton, CA 95202-3029 �p�u <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> ' ENVIRONIVIEN r HEALTH <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 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 any violations, are to be submitted using this certification 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 <br /> billed at the current hourly rate. <br /> For this certification t0 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/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: 6/a,1 ja Inspected By: s u,)'¢/A N CN d v�Il� <br /> Facility Address: 70 1 e , VUaV EPA ID#: C A L ayo 2,15 <br /> I certify under penalty of law that: <br /> 1� I have corrected the violations specified 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 /> ,t',.. ._1 , .,_. 'Ll-ie <br /> EACH y wv-,�wiv ai iu i uCi�cvG trl hp tri IP, Af:RI IrgtPand compete: <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware teat►iere are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violabut ia. (H3025 i 91) <br /> Name: 9 W AIZA"J Lftou H "'j Title: UU-) N 61� <br /> Signature: S� Date: Z_ p <br /> EHD 22-02-005 Rev 10109 <br />