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Apr 11 12 07:03p R. PHILLIPS TRl' —'ING,LLC 20" 948-0840 p.2 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> . 1 moi. <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sigov.onglehd <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 fii-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 (I R) 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 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!manifestsftraining records/other appropriate paperwork, andlor photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date Inspected By. <br /> Facility Address: EPA ID#;22& <br /> I certify under penalty of law that: <br /> 1. 1 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 /> EACH VIOLATION and I believe the information to be true, accurate, and complete` <br /> Photos ` .Paperwork Statement <br /> 3- 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine andforj'Lnprisonment for known violations. (HSC 25191) <br /> Name: Title,,��!CL /�� <br /> Signatu <br /> Dat <br /> EHD 2212-005 Rev 10109 <br />