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SAN • Q. iOGRAM AGENCY <br />r. • •. HEALTH DEP RTMENT <br />304 E. WEBER AVENUE <br />STOCKTON, <br />• • • • ki :111 <br />For Hazardous Waste Generators <br />In the matter of the Violation cited on: <br />As Identified in the Inspection Report dated: <br />Conducted by: [EHD Inspector(s)] <br />I certify under penalty of law that: <br />1. Respondent has corrected the violations specified in the notice of <br />violation cited above. <br />2. 1 have personally examined any documentation attached to the <br />certification to establish that the violations have been corrected. <br />3. Based on my examinationof the attached documentation an•i <br />inquiry of the individualswho prepared • obtained • - <br />lieve that <br />the information is true, accurate, and complete. <br />4. 1 am authorized to file this certification on behalf of the Respondent. <br />5. 1 am aware that there are significant penalties for submitting false <br />information, including the possibility of fine and imprisonment for <br />knowing violations. <br />Facility Address <br />Name (Print or Type) <br />Signature <br />EHDCERT (rev 1/07/02) <br />Title <br />