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07/06/2006 14:34 1 SANBORNCHEVROLETINC PAGE 03/05 <br /> SAN JOAQUIN COUNTY '�- <br /> ENVIRONMENTAL HEALT14 DEPARTMCNT <br /> 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 <br /> Tele hone:(209)468-3420 Fax:(209)468-3433 Web:w�ov.orj/eh.d <br /> RET RN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations no ed in the"Notice to Comply" in the attached inspection report must be <br /> corrected,within 30 days o receipt of this inspection. This certification form must be submitted to t <br /> Environmental Health Dep rtment(EHD) address at the top of this form within 35 days of receipt of t e <br /> inspection report. <br /> All corrections to other vio ations noted in the attached.Inspection Report(IR)or Continuation Form, or <br /> disputes to any violations, re to be submitted using this certification and returned to EHD within 60 days <br /> unless otherwise specified.n.the JR. <br /> For this certificati n to be COMPlete the operator of the site must include: <br /> • A statement docum rating what corrective actions were taken or will be taken for each violation <br /> • Copies of sample r sults/manifests/training records/other appropriate paperwork,and/or photos <br /> verifying correctio s <br /> • Operator's certif ca ion <br /> Inspection Date: Inspected By: <br /> Facility Address: N. EPA ID#: <br /> I certify under penalty f law that: <br /> _ 1 have corrected the violations specified in the Inspection Report from the above-mentioned, <br /> inspection date. <br /> 2. I have personally ex ined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATJO and I believe the information to be true, accurate,and complete: <br /> Photos Paperwork Statement <br /> 3. I am authorized to si bmit this certification on behalf of the Respondent. <br /> 4. I am aware that Cher are significant penalties for submitting false information, including the <br /> possibility of a fine nd/or imprisonment for known violations. (HSC 25191) <br /> Name: ,J E 6;--415 Title: c��'f(�U cG W{r4A3A� <br /> Signature: �i=�r Date: <br /> EHD 22-02-005 Rev 12-04 <br />