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(9 SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, P Floor, Stockton, CA 95202-2708 <br />Telephone. (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgov. <br />1 1:1 ON all II h!'11 511111111115 1 1111 1 1 04 t1a <br />WILY J, rTW <br />Ly -j-i7LWjS,•i im <br />inspection report. <br />1�� 1111 1 <br />iqgiilg�ij lrrrvrii <br />I 1 11 i I I I its) Ilia qim <br />u1sputes to wLIJ, ;,101dL10R5, �IrU to Ot; SLUMILLCU LbIng UjLh UU11111CUL10n,'Alu retume0716-EM10-WM1n m!LgM <br />unless otherwise specified in the IR. <br />•I 1 1111111111111 111111111111 1 :� III ;Iiii;;I� 1 11 !111 ; i ii��ij <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 />e Operator's certification <br />[04mol?451 <br />I certify under penalty of law that: <br />inspection date. <br />Inspected By: <br />1111111111111 11 , II- 1 1, <br />11 sljqjppiii!1�11 qpiijji��111111111-��- 0 4111iI11111 I <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 />;RIIIINNKI�W <br />1-07-Te"I IT- M, <br />4. 1 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 />am <br />1I 1III I - <br />