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SAN JoAQunv COUNTY " "':WEDI I <br /> ENVIRONMENTAL HEALTH DEPARTMENT t <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Tele hone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd OU T 1 2 2010 <br /> ENVIRUNIMEN! HEALTH <br /> PERMIT%SERVICES <br /> TURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations n ted 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 Der artment(EHD)address at the top of this form within 35 days of receipt of 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 30 days <br /> unless otherwise s ecified ' the Inspection Report. <br /> Note: All EHD sff tim associated with failing to comply by the above noted dates will be billed at <br /> the current u <br /> horl7 rate(. 122). <br /> For this cert ficat n to be complete the operator of the site must include: <br /> • A statenia it docun entingg what corrective actions were taken or will be taken for each violation <br /> • Copies of iample sults/manifests/training records/other appropriate paperwork,and/or photos <br /> verifying orrectio is <br /> • Operator' certification <br /> InspectionDate Sept mber 2, 2010 Inspected By: Garrett Backus <br /> Facility Address: 403 N EI Dorado Street EPA ID#: CAL000161075 <br /> I certify under penalty of law that: <br /> 1. I have corrected th violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I have per nally a amined the following documentation submitted as proof of compliance FOR <br /> EACH' I LATIC N and I believe the information to betrue,a urate, and complete: <br /> Photos--V—Paperwork Statement <br /> 3. 1 am authoi 'zed to ubmit this certification on behalf of the Respondent. <br /> 4. I am 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 /> r r <br /> Name: Title: ��4e f t eM <br /> Signature: . Date: Q <br /> EHD 22-02-005 Rev 08/10 <br />