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0 SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply" in the attached inspection report must be <br />corrected within 30 days of receipt of this inspection. This certific ation 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 />Iv <br />Ow <br />LhIll?, LHIS MMIIUULII�nant TETTRieft LIT, M17, MD <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 />9 Operator's certification <br />RMTOMMMUM <br />Inspected By:, <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 Paperwork StatemejEj <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 />ME <br />10:1 1 #1 1 - I 1 <br />