Laserfiche WebLink
04/17/2008 13:34 5035241,2QO RUTH HA - BP PAGE 06/06 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL 4tALTH-DEPARTMENT <br /> 600 Fast Main Streef,Stockton,CA,95202-3029 <br /> Telephone. (209)468-3420,Fax. (209)468-3433 Web. www..qjg2X.orp/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MIN—OR violations noted in the"Notice to Comply"in the atlachedInspection Report must be <br /> corrected Within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EHD)address at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All corrections to other vio <br /> ,lations noted in the attached Inspection Report(IR)or Continuation Form,or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. <br /> Note., All EHD staff time associated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate($98). <br /> For this certification to be complete the operator of the site must include. <br /> 0 A statement documenting what corrective actions were taken or will be taken.for each violation <br /> 0 Copies of sample results/manifests/training records/other appropriate paperwork,and/or photos <br /> verifying corrections <br /> e Operator's certification <br /> Wpection Date: J/ ay Inspected By: <br /> Facility Address.-_2* EPA ID#:1? <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-tricntioned <br /> ins&cfion date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the infortfiation to be true, accurate, and complete: <br /> Photos---Y, --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: Title: <br /> 7-- <br /> Signature: Date: 44131,41by <br /> EHD 22-02-005 Rev 1.1./07 <br />