Laserfiche WebLink
11129/2010 14:54 209577GPd0 BOVETT OFFICE PAGE 02109 <br /> 11/23/2010 TUE 13x31 FAX 20 :3433 SJC EHD rao08/008 <br /> SAN JOAQ U IN CO U NTY <br /> 1rNV1RoNMENTAL HEALTI.1 DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95242-3029 <br /> r'rlaphone.(209)469-3420 Fax:(209)463-3433 Web: <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 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 EIHD within 30 days <br /> unless otllerwise specified in the Inspection Report. <br /> Mote: All ERD staff time associated with failing to comply by the above noted darter will be billed at <br /> the current hourly rate ($I 15). <br /> For this certification to be COmplete the operator of the site muss include: <br /> 9 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 paptnWoric, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: 11 -2�4_10 Inspected By: k1C K J-t'W R. <br /> 137 N - 1.1k-WO P lZ b <br /> Facility Address: (N WTCA t CA �5334o EPA ID#: �(�7a��- <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in die Inspection Repoli from the above-mentioned <br /> inspection date. <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, a,.d complete: <br /> Photos ✓ Paperwork ✓/ StateTnCllt <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. I 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 /> O � 7►�y Title. <br /> :Name: <br /> Signature: 1/V Date. <br /> EHD 22-02-005 Re 1/07 <br />