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HN. ALU <br />SAN JOAQUIN COUNTY <br />AUG 0 2 2010 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />SAN JOAQUiN COUNT`! <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.si-gov.org/ehd <br />ENVIRONMENTAL <br />HEALTH D9t'A T.hSGNT <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 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 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 <br />billed at the current hourly rate of $105 (beginning 8/1/09 the hourly rate will be $115). <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 />verifying corrections <br />• Operator's certification <br />Grrwle-CTf 0404-0G <br />Inspection Date: .12 /y p Inspected By: -i NOY TaAi�3 <br />Facility Address: /VVLjZ-J 9-2LyH L)jZ, 5,701,4 EPA ID#: CAL—OC)Od SCii�3 <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. 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 X Paperwork X 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 and/or imprisonment for known violations. (HSC 25191) <br />Name: Rti r, CiM;-Oy Title: NWknN�6 �` <br />Date: <br />EHD 22-OM05 Rev 06109 <br />