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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Stivet, Stockton, CA 95202-3029 <br />Telephone. (209) 468-3420 Fax: (209) 468-3433 Web. MMMLsjgoy.orgLehd <br />1 1113 It 111 i'li 1111i iii i'111111 i'llim 10 in IF101 q- 1141 DKOUR ti'lii <br />Any MINOR violations noted in the "Notice to Comply" in the attached inspection report -must be <br />corrected within 3 0 days of receipt of this inspection. I This certification form must be submitted to the <br />Enviromnental Health Department (EHD) address* at the top of this form within 3 5 days of receipt of the, <br />inspection report. <br />l� 07 <br />unless otherwise specified in the IR. <br />For this certcation to be completethe operator of the site must include: <br />A statement documenting what corrective actions were taken or will be taken for each violatioll <br />Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br />verifying corrections <br />Operator's certcation <br />I MT61-M RIT MM <br />WW"UMUS1' - <br />• <br />Wi.1119167M -I <br />1. 1 have corrected the violations speced in the Inspection Report from the above-mentioned <br />inspection date. <br />2. 1 have personally examined f documentation submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, accurate, and complete: <br />Photos Paverwork Staterneal <br />1! - <br />111111 W i� 99awil ==16TIM141 # <br />Name: Title: <br />LM <br />Jill 11111, 1 �. I I I <br />