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Jul 09 2007 16: 10 Te-nro 559585-0449 p. 2 <br /> SAN JOAQUIN COONTX <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E. Main St.,Stockton,CA 95202-3029 <br /> 7'eJephane:(209)468-3420 Fax:(209)469-3433 web:WYW,Aj8-0YLQr&/ <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the "Notice to Comply"in the attached inspection report roust be <br /> cklle-c--194 withia30 dM 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 g2rrectigns to Other violations noted in the attached Inspection Report(IR) or Continuation.Forin, or <br /> disputes to any violations, are to be submitted-using this certification and returned to EHD within 60 days <br /> unless otherwise specified in the 1R. <br /> For this Cet'tifiCa ion 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 plxttos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: ID-q/0-7 Inspected By <br /> �),,H 9 W. ec—H-len-\�n L-0 rn 9-- <br /> Facility Address: C-1EX4• 11 C EPA ID#: Csr,-�,cy--�C)14al <br /> I certify under penalty of law that.: <br /> L I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> r <br /> I <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_k—Statement <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 /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name:_ rc s Title _ c <br /> gnature. <br /> Si •Q <br /> ? _ _l <br /> 1 <br /> EsHD 22-02-005 Rev 05-07 <br />