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SAN JOAQUIN COUNTY 7-7Z <br /> ONMEWM,HEALTH DEPART <br /> ENVIR 'vIFNT <br /> 600 E. Main St.,Stockton.CA 95202-3029 <br /> Telephone:(209)468-3420 Fax. (209)468-3433 Web:m w�.sgoyorgehd <br /> MAR 04 2010 <br /> SAN <br /> RETURN TO COMPLIANCE CERT1F1CAT1q$,":` <br /> H D5 !TEAENIT <br /> Any MINOR violations noted in the"Notice to Comply" in the attached inspection report must be <br /> corrected within-29-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 fann within 35 days of receipt of the <br /> inspection report. <br /> All corrections to other violations 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 EMD within 60 days <br /> unless otherwise specified in the IR. <br /> For this certification to be completethe 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 ate: a,410 Inspected By: <br /> Ha 4 10 YTN(A n Lo/Ae- <br /> 1 Facility Address: EPA ID#: CAW ow P-1- <br /> I certify under penalty of law that: <br /> 1. 1 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 /> EACH I VIOLATION and I believe the information to be true, accurate,and complete: <br /> Photos__.;Paperwork Statement <br /> 1 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 n E"r-a� Title <br /> I Signature:,.° ,L �: ,C Ck Date: 3/ L+//L) <br /> I I I <br /> EHD 22-02-005 Rev 05-07 <br />