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GAS - ENVIRONMENT L Fax:2148416147 Au.- 16 2005 15:35 P. 07 SAN JOA,QUIN COUNTY ENNIRONMENTAL HEALTH DEPARTMENT 04 East Webcr Avenue,3'd Floor,Stockton, CA 95202-2703 T'eleph one: (209)468-3420 Fax: (209)468-3433 Web.www,siQov-QEglehd RETURN TO COMPLIANCE CERTIFICATION Any.MINOR violations noted in the'Notice to Comply, in the attached inspection report must be corrected within 30 dans of 1 eeeipt of this inspection. This certification form must be submitted to the Environmental.Health Dep ent (EHD) address at the top of this form within 35 days of receipt of the inspection report. A.11 corrections to of er viol tions noted in the attached Inspection Report (IR) or Continuation,Form,or disputes to any violations, a to submitted using this certification and returned to EHD within 60 dans unless othezwise-Pecifi d ' the IE?. . For this certificati n to be complete the operator of the site must include: • A.statement documenting what corrective actions were taken or will be taken for each violation • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying correction • Operator's certifxca ion Inspection Date: HJT Inspected By: Facility Address: 7 coo (�-�ne i�- EPA ID#: I certify under penalty f law that: 1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 2. I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATIO and I believe the information to be true, accurate, and complete: Photos Paperwork ,.Statement 3. I am authorized to ubmit this certification on behalf of the Respondent. 4. I am aware that there are.significant penalties for submitting false information,including the possibility of a fine and/or imprisonment for known violations. (HSC 25191) '_- ' Gasoline & Environmental Compliance Manager Shane Nartridge Title: anal . . .... Signature: , ,rDate: EHD 22-02-005 Rev 12-0