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Jul 26 07 03:32p Lower Sac Chevron 2099540582 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 East Weber Avem, , 0 Fkw, Stockton, CA 95202-2708 3'ekpkone. (209) 468-3420 Fax. (2099) 468-3433 Web: www,kjeoy.oarlehd RETURN TO COMPLIANCE CERTIFICATION P.1 Any MINOR violations noted in the "Notice to Comply" in the attached inspection report must be corrected within 30 dans of receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address at the top of this form within 35 days of receipt of the inspection report. All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations, are to be submitted using this certification and returned to EHD within 64 dans unless otherwise specified in the 1R. For this certification to be complete the operator of the site must include: • A statement documenting what corrective actions were taken or will be taken for each violation • Copies of sample results/manifests/training recordslother appropriate paperwork, and/or photos verifying corrections • Operator's certification Inspection Date: Facility Address: 0G VC3v`i2. S �-t I certify under penalty of law that: N Inspected By: EPA ID#: CA L 0 g o '3e 0 �-J-,f 3 1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 2. I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate, and complete_ Photos Paperwork Statement 3- I am authorized to submit this certification on behalf of the Respgndent. 4. I am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or imprisonment for known violations. (HSC 25191 ) Name: JML tg'o a I/"-- Title: Lsm i D � Signature: t �f Date: 7 0-6 EHD 22-02-005 Rev 12-04