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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E. Main St.,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attache s ction Report must be <br /> corrected within 30 days of receipt of this inspection. This certificatio ' st u <br /> Environmental Health Department (EHD) address at the top of this fo <br /> Inspection Report. <br /> All corrections to other violations noted in the attached Inspection Report or Confinuli n Nrm, or <br /> disputes to any violations, are to be submitted using this certification and retuMgA% 1Djgi ' 30 da s <br /> unless otherwise specified in the Inspection Report. ENVIRONMENTAL <br /> 0 HEALTH DEPARTMENT <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate ($tW). <br /> 12L_:2 <br /> For this certification 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 photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: -7/2 19, I( Inspected By: J-1(- _ C 0:5 <br /> Facility Address: 'i tj o w . ,-(,A.<_4-ev W!!!,% EPA ID#: <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. 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: ►� r2 S �` H Title: C�1,0 q­L� <br /> Signature: Date: "I <br /> EHD 22-02-005 Rev 08/10 <br />