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[qDFCE�\VJF5DD <br />RETURN TOC <br />OMPLIANCE CERTIFICATION <br />MAY 1 1 2009 <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspecti -ItHEALTH <br />be corrected within 30 days of receipt of this inspection. This certification form41 o <br />submitted to the Environmental H . , 1ITIS R�1tCE� <br />Health Department (EHD) address at the top of this form within <br />35 days of receipt of the Inspection Report. <br />All corrections to other violations noted in the attached Inspection Report or Continuation Form, <br />or disputes to any violations, are to be submitted using this certification and returned to EHD <br />within 30 days unless otherwise specified in the Inspection Report. <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be <br />billed at the current hourly rate ($105). <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 <br />violation <br />• Copies of sample results/manifests/training records/other appropriate paperwork, and/or <br />photos verifying corrections <br />• Operator's certification <br />Inspection Date: 9-5-08 <br />Cacapit <br />Inspected By:Aris <br />Facility Address: 1190 Cherkee Ln Lodi CA 95241 EPA ID#:CAD054598289 <br />I certify under penalty of law that: <br />1. I have corrected the violations specified in the Inspection Report from the above- <br />mentioned inspection date. <br />2. I have personally examined the following documentation submitted as proof of <br />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 />the 4. I am aware that there are significant penalties for submitting false information, including <br />possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />Name:Jerry Curtis �' Title:Service <br />