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SAN JOACAJM COLWTY <br /> EHvi�ot a'r't+D� 2�� <br /> eW Fast Wn street.3tocktort, 33 Web. s d <br /> (209)468.3420 Fax.(209)468 <br /> PLIANOE CERTIFICATION <br /> RETURN TO COM <br /> Inspection Report must be <br /> o Cornw in the subrnitW to t4�e <br /> Nil R violmtioits noted into N Evan must be <br /> Any I` 04 receiptOf arwe�- This <br /> dsthe PthtS forrn <br /> 'min 30 days of receipt of the <br /> Erni�vnment2�Hem Dape��� � <br /> Inspection Report' UR)or Co lJin+��n Form, or <br /> n noted in the attaches Report�. �j t ed to EHD <br /> All s to o to be submitted udn9 this <br /> c9rdFicelon arid <br /> disputes to any violations, are <br /> specified in the lrtisPeadon b 1 e above noted d�WHI be <br /> Un athe � to comply y <br /> time <br /> associat5ed with fail►o9 <br /> None. All EMD staff rate of$,MV�eglenirnt} <br /> billed at the current hourly I�r <br /> rrl Tete the opt of the sit®must include: <br /> For this certification to be CO l3 w� �, or wilt be taken for each violation <br /> what corrective actio rwork,and/or photos <br /> . A statement 'men WM8r�ifests/traiNng recordslooW appropriate Iain r--_ <br /> . Copies of sample res � <br /> verifying ions - <br /> pperaWs certification �L- 19 rc <br /> • $ <br /> o L o kopecud BY: � <br /> U.Mpe4�tion Date: !.-x-0 " <br /> P O (}ND SA-- 'EPA 00 <br /> FaoiHty I�"�,a,.��s i"' o w� t-A'0t%ZW ?--- i <br /> I �r61y under genaity of law that: <br /> d Ow viola'1 Ws specified <br /> the ji,%S n RepO't�the abo�va-mentlor�ed <br /> 1 inspection date. as proof of comP "�O FOR <br /> Person!"" <br /> follawin9 doc t 1e sulxn►tted e,and co'nplate" <br /> 2. I have Pe !""a in'd th the infarrnaWn to be true.amt <br /> EACH VIOLATION and 1 believe <br /> photAs Paperwork <br /> it <br /> �— ��of ft Rsspt' <br /> on <br /> authorized to submit;l'tts �R,inck3 tie3, I am that there are signw":;ant penaM (IISC��gt) <br /> 4. i possibiMyof a fine and/or imPrisonrneM for known <br /> Td1a; <br /> Ip <br /> Name' pais; <br /> Erio o2�os fwv 06M <br />