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4 01/,19/2008 09:07 12099511252 FIRESTONE HAMMER LN PAGE 02/02 <br />SAN JOAQUIN COUNW <br />)ENVIRONMENTAL HEALTH DEPARTMENT <br />600 Eastain Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468- r420 F= ( 209) 468-3433 Web: wwwsiggy.o <br />1:40VOCIVOK11 <br />Mnwml # <br />@A�A <br />11 1 11111�11�111qiiji <br />: 1111`1 1 1 1 V <br />11111flill I i I i 11 �: , Y <br />unless otherwise specified in the IR. <br />For ffiis certification to be complete the operator of the site must include: <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 />* Operator's certification <br />Inspection Date: -7i pected By -&,4* <br />Facility Aftess: 7Zc) g--AAlev 5V*- 64 EPA 01000 qe7 1A <br />I certify under penalty of law that: <br />I, I have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br />F-ACWVIOLAT-ION and I believe the information to be true, accurate, and complete: <br />—Photos —Paperwork '>< Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <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 />Name: T <br />itle: <br />is <br />01 - <br />FTM'71-07-005 R" 05/07 <br />