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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton,CA 95202-3029 Telep one:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd RETU TO COMPLIANCE CERTIFICATION Any MINOR violations nod in the"Notice to Comply" in the attached inspection report must be corrected within 30 days o receipt of this inspection. This certification form must be submitted to the Environmental Health Dep ment (EHD) address at the top of this form within 35 days of receipt of the inspection report. All corrections to other viol tions noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations, a to be submitted using this certification and returned to EHD within 60 days unless otherwise specified i the IR. For this certificati n to be complete the operator of the site must include: • A statement docum ting what corrective actions were taken or will be taken for each violation • Copies of sample re ults/manifests/training records/other appropriate paperwork, and/or photos verifying correction • Operator's certificati n Inspection Date: 710 f Inspected By: Facility Address: c� E. ! EPA ID#: AL, QC) 1V31rJ I certify under penalty of law fhaf: ' 1. 1 have corrected the v olations specified in the Inspection Report from the above-mentioned inspection date. 2. I have personally exa fined the following documentation submitted as proof of compliance FOR EACH VIOLATION d I believe the information to be true, accurate, and complete: _Photos_Paperwork _Statement 3. I am authorized to sub it this certification on behalf of the Respondent. 4. I am aware that there a e significant penalties for submitting false information, including the possibility of a fine an /or imprisonment for known violations. (HSC 25191) Name Title: ` ► C C L.g; Signature• ,' �'t'`,`j ,. Date: - i EHD 22-02-005 Rev 05/07