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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1866 East Hazetton Avenue, Stockton, CA 95205-6232 <br /> lephone:(209)466-3420 Fax:(209)4683433 Web:www.sieov.orglehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violatio(is noted In the'Notice to Comply°in the attached Inspection Report must be <br /> corrected within 30 lavs of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Heal IT Department(EHD)address at the top of this form within 30 days of receipt of the <br /> Inspection Report. ISC 25404.1 2(c)(1) <br /> All corrections to of er violationq noted In the attached Inspection Report(IR) or Continuation Form, or <br /> disputes to any vloh itions, are to be submitted using this certification and returned to EHD within 3D days <br /> unless otherwise s cified in the Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD st,iff time associated with falling to comply by the above noted dates will be <br /> billed at t current hourly rate. <br /> For this certification t0 be complete the operator oflhe 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: ALU t z Inspected By: T C ?1( r <br /> Facility Address s 64AOiti EPA ID#: <br /> `C R PY-Cgr <br /> I certify under 1 isnalty of law that: / <br /> 1. I have corn cted the violations specified In the Inspection Report from the above-mentioned <br /> Inspection date. <br /> 2. 1 have personalty examined the following documentation submitted as proof of compliance FOR <br /> EACH VIO TION and I believe the Informatio o be true, accurate, and complete: <br /> Photos Paperwork—ZStatement <br /> 3. lam autho ized to submit this certification on behalf of the Respondent. <br /> 4. I am away that there are significant penalties for submitting false Information, including the <br /> possibility f a fine and/or imprisonment for known violations. (HSC 25181) <br /> Name: l v Title: oar n2L a <br /> Signature: Date: — t S � � L� <br /> fiHo zz-a2m6 aeY Darn <br />