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NICK ARBABIAN P.1 <br /> PC. <br /> lit SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT DEC 19 2008 <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telep%oraa: (209)468-3420 Pax. (209)468-3433 Web:www.s_lgW_bQA9j19L, <br /> ENVio ---'"uUNTY <br /> '0i'VMSN_rAL <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to CompW in the attached Inspection 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 30 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 EHD within 30 days <br /> unless otherwisetpecified in the Inspection Report. <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> For this 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 recordstother appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: I /0,R ins pectedBy: .4AJ1APPA NA-)by <br /> Facility Address:_]�SCJC1 S-VAZLAIJ P—D LA 74 EPA ID#: <br /> qyvo <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 VIOLATION and I believe the-information to be true, accurate, and complete: <br /> Photos--,Zpaperwork 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: C <br /> AA/a r-JA <br /> Signature: Date: <br /> EHD 22-02-005 Rey 08108 <br />