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26-Aug-2010 10 :42 AM Arrow Sign Company 2099315844 6/10 <br /> ._,r.:- _ —r' `.�•'--r— ^—-^�='r e'- 'sem— '•i —.G, . ;ceT--r— '— — <br /> its - <br /> - SAN JOAQUIN COUNTY ,4 <br /> ENVIRONMENTAL HEALTH.DEPARTMENT- 8 <br /> 60b East Main Street,Stockton,CA 95202-3029 <br /> -• Telephone:(209)468-3470 FaZ(208)468-343S�,Web:rwww.sigoy:b�g/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted�in-the"Notice to'Comply" in�the a ttached'Inspection Report must be <br /> corrected within 30=.dawdf•receipt._of.this inspections This certification form must be-submitted to�the <br /> -Envirorirnental Health Department(EHD) address attthe.to-,p of this_-form_within 30 days of receipt of the <br /> Inspection Repoit,All corrections}to other violations noted in the attachedInspection Report.(IR) or Continuation Form, or <br /> disputes'to any violations, are to`be submitted using this certification and returne_d.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 /> FOC th s cerlificatio ' to beh Comp' fete the operator-of:the site must include:'. <br /> A statement dodumentin what corrective actionS_Were taken-or willbe taken for�each;violation <br /> • Co�ies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> ve rlifying corrections — <br /> • <br /> Operator's certification <br /> Inspection Date: l© 13' txj Inspected By: <br /> Facili_tFj,Address:31`33. U. i4o "�o EPA ID#: .C�Rt D o0Z-"�5 331 <br /> j 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. II have personally examined the following documentation submitted as proof oftompliance FOR <br /> TEACH VIOLATION and'1-believe'the.'information to`be true,'-accurate;and:bomnplete:- <br /> Photos Paperwork _ Statement <br /> - . <br /> 3. i 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 /> Dossibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: l�A2,IAW Title: ud- his�� reran 2� <br /> Sigp ature: Date: F12-(, 1 0 <br /> EHD 22-02-01 5 Rev 08106 <br />