Laserfiche WebLink
11-02-1996 1 :01AM FROM YOSEMITE ARCO 2098258655 P- 3 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor,Stockton,CA 95202-2708 <br /> Tdepl one:(209)468-3420 Far:(209)468-3433 Web.www.siQay.or <br /> r <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any 1MI OR violations noted in the"Notice to Comply"in the attached inspection report must be <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department (EHD)address at the top of this form within 35 days of receipt of the <br /> inspection report. <br /> All cotre Was 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 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 violation <br /> • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> Operator's certification <br /> Ins ecrion Date:_y y <br /> p � � Inspected By: I� ilk <br /> Facility Address: A;7// 6C aS --k EPA ID#: L 000 22 '—'�- <br /> I certify under penalt .of law fhatC a) C74 <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I 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 /> Photos Paperwork Statement <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4. Y ann aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Nam ��e��C Title: 6111,1iAgZ <br /> C-o �i Signature: Date:Date: I 2 <br /> T:TJT1" Al AAc ri__. i't AA <br />