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• 0 p.1 <br />SAN 3DAQUIN COUNTY <br />UNvilrONMENTAL IiHALTII DL.'f ARI'MhNT <br />600 Viav Main Strcet, Stockton, CA 95202-302 <br />Tr[e'plmnc: (209) 468-3426 Fox: (2119) 468-3433 Wt*. %h w,sjt ov.org/and <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection RLWA must be <br />corrected within 30 day!-! of receipt of ihi.s inspection. This certification form must be submitted to the <br />Environmental Hcalth Dcparunent (I;IID) address at the top of this form within 35 days of romipt of the <br />Inspection Report. <br />Ali corrections io other violations noted in the attached inspection Rgpor (IR) or Continuation Form or <br />dis utcw to any violations, are to be submtWd using tlNs fi(. <br />ccrtidionl and returned to EHD within 30 days <br />unless otherwise specil ied in the: Inspection Report. <br />Vote: All ERD staff time associated with failing fia comply by the above noted dates will be billed at <br />the current houtrl , rate ($122). <br />For this certification to be CDi]1IP1CIe the operator of the site must include: <br />• A statement doeumantin what corrective actions were taken or will be taken for each violation <br />+ Copies of sample results7ivanifestsltraining reoords/other appropriate paperwork, and/or photo <br />verifying corrections <br />e Operator's certification <br />Inspection Date: March 29, 2011 <br />Inspected By: Garrett Backus <br />Facility Address: 720 E Hammet' Lane #1 EPA ID#: CAL000049151 <br />ce rtify under penalty of law that. <br />1. 1 have corrected the violasions specifcd in the lm-pection Report from the above-mentioned <br />inspection date. <br />2. 1 have per%onalty exatnincd tlnr fallowitig documentation submittod as proof of eompliaoce'f70P, <br />EACI I VIOLATION and 1 believe the information to be true, a %xutc, and complete: <br />Phottn _Paperwork _ statetnc.-rnl <br />3. ]fun authorised to submit this certification on behalf of the Respondent. <br />4. lam aware that there arc significant penalties for submitting False information, including the <br />possibility of a fine and/or imprisonment for known violations. (TISC 25191) <br />Name: �y�A ) ec ^ I N <br />Signature Bate �v�iv 11 <br />1~ HD 22-02-005 R 08/10 <br />