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08/08/2008 13:09 5628662787 114 PAGE 02/02 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEA.'-TFI DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> s' <br /> Telephone:(209)468-3420 Far:(209)4.68-3433 Web: www.sigov,org/e*, <br /> Skv <br /> RETURN TO COMPLIANCE CERTIFICAh6N, ` � <br /> r >l. <br /> AnyMINOR 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 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 billed at <br /> the current hourly rate ($98). <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 betaken 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: k1rj(k Inspected By:_ )�' A c_ <br /> Facility Address: EPA ID#: 0,9Lc)no©j-)g6-72_ <br /> a 4gLl <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. I 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-__,X_Papervork _Statement <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for s ibmitting false infortnation, including the <br /> possibility of fine and/or imprisonment for known violations. (HSC 2519 1) <br /> `Title: �-' ��t - <br /> Signature: �, ,� q��,s�,a Date: <br /> P14r) Ps-v t t im <br />