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002454 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Rno f=ast Main Street, Stockton, CA 05202-3020 <br /> Telep'•onu:(209)468-3420 Fax:(209)468-3433 Web:www.Slgpvr�/eh� <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 day-, 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 violatiQns 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 tho current hourly rata. <br /> For this certification to 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 /> vorifying oorrootiono <br /> • Operator's certification <br /> Inspection Date: 10—aa-10 Inspected By: CDCAp. f <br /> Facility Address: `fid �v5aciatneA6 �Y tDeb gSoyo EPA IU?#: eA_L XQa555523 <br /> I certify under penalty of law that' <br /> I. I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection data <br /> 2 1 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: l <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> I <br /> 4 1 am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (NSC 25191) <br /> Name rA 1tX(Y--\CarA2er Title. VI C. pire5Idcri <br /> SignatureDate- <br /> EMD 12-02-005 Rey OWDS <br />