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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgov.orgLe <br />1690111-Wilh'i 1 '11,11,13 111 11.r.1104-1 imp•% � I <br />I I ; , 1 on <br />Any MINOR violations noted in the "Notice to Comply" in the attached inspection report must be <br />corrected within 30 dgys of receipt of this inspection. This certification form must be submitted to the <br />inspection report. <br />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification and returned to EHD within 60 days <br />unless otherwise specified in the IR. <br />For this certification t® be completethe 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, /or photos <br />verifying corrections <br />• Operator's certification <br />am=i� <br />Emm <br />MMMM <br />1. 1 have corrected the violations specified inthe 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 />;9111000L= M_ 1"Im- IT, <br />#14j: g ) t I) I I I FM I . a I 14 t W. 1114 Fff 0) a I I I 14 j I R1 0) 0 1 i U-1 I I a 10) a "A I Lawa I KV u9j, K 14 E9.3 I Im ge <br />• <br />SW= <br />a <br />1111,11111111 �I 1 0 - I <br />"M <br />I, m <br />