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0 SAN JOAQUIN COUNTY 0 <br />ENVIRONMENTAL HEALTH DEPARTMENT R <br />1868 East Hazdon Avenue, Stockton, CA 9520"232 t,,EIVED <br />e <br />Tekphone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sigqv.MLeh APR 17 20i.,j <br />ENWRMNMENTAL HEAr, jj <br />RETURN TO COMPLIANCE CERTIFICATION PEr"All" '/SFEFPVICES <br />lufs of <br />Inspection Report. HSC 25404.1.2(c)(1) <br />-4ote: All EHD staff time associated with failing to comply by the above noted dates will trz- <br />billed at the current hourly rate. <br />For this cercation 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 resufts/manifests/training records/other appropriate paperwork, and/or photos <br />verifying corrections <br />• Operator's certification <br />Inspection Date:_ J/ "s Inspected By: UW1 • ^t\r-)6 K I I <br />1 4 ! 11 <br />Facility A• k aLQ, EPA ID#: 6 AL- 000 <br />I certify under penalty i1f1akvw"tkhatt.*QA CA 61 S:�)-3 & <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentionei <br />inspection date. <br />Photos -�C—Paperwork Statement <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 />Siqnature: I <br />EHD 22-02-005 Rev 08/11 a0cl- 2)13a COILS -60 <br />Em <br />nA,q n P re-tt b' <br />kalm <br />