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11/29/2010 14: 54 209577FP40 BOYETT OFFICE PAGE 02/09 <br /> 11/23/2010 TUE 13131 FAX 2 j83433 SJC ZED 12008/008 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALT11 DEPAaTMENT <br /> 600 Fast Main Street,Stockton,CA.95242-3029 <br /> x'elaphone:(209)469-3420 Fax:(209)468-3433 Web. Lsj eov.prg�W <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be <br /> cot7ected 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 35 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 EMD within 30 dans <br /> unless otherwise specified in the Inspection Repoli. <br /> Note: All EIID staff time Associated with failing to comply by the above doted dates will be billed at <br /> the current hourly rate($115). <br /> For this certification to be complete the operator of the site muse.include: <br /> 0 A statement documenting what corrective actions were taken or will be talccn for each violation <br /> Copies of sample results/manifests/training records/other appropriate paptiwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: 11 r 2 X4-10 inspected By: Ql,�2 K 3"t-W EU- <br /> 1137 W , LAT1AaP Rb- <br /> Facility Address: ("A PTFC1 t CA - g5334o EPA ID#: CAL-600-3 4054 <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 ✓ Paperwork ✓/ Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 arta 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: <br /> YZ-O VZ Y Title: W�j . `W'U- �v . <br /> Signature: Date: 11` '�IQ <br /> BHD 22-02-005 Re 1/07 <br />