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-May -11-2005 03:37pm From-CONOCOPHI ' S ENV COMPLIANCE 510 245 5179 T-535 P•006/008 F-383 <br />SAN JOA,QUIN COUNTY <br />ENVMONMENTAL RBALTFi DEPARTMpNT <br />304 Ea6l weber Awm e* 3'd Floor, Stocloon, CA, 85202-2708 <br />TelePhoae: (20'8) 468-3420 Fmrt (209) 4683433 Web. www ov_ t /c <br />'. T ' T, COMPLLANC E CERTEFICATION <br />Any hQ R violations noted in the "Nance to Cosnpl3�' axt the d zazs ectaon <br />corrected within 30 days ofreceip�t of this ' F �p� must be_- <br />En'uiroMental Health Department HD�P ion. This cextifir.ation farm must be submitted_to the <br />inspection report. <br />address at the top of this fog within 3� days of receipt afore <br />All corrections tor violations noted in the attached Inspection Report (JR) or <br />disputes to any violara.ons, an to be sttbrnitt..cl "sing � ( ) Continuation �vrm, or <br />unless otherwise Specified in the A g his eccatiatt and returned to within fi0 days <br />For this CeitxfCatxon to be con1picte the opm#or of the site must inWude: <br />• A statcmeaat documenting what corrective actions were taken or will be taken for each violation <br />• .Copies of sansple resWts/manifests/training records/other approptiate paper�rodc, and/or photos . <br />'verifying corrections <br />• Qperator's certification <br />Inspection Date. /( <br />Inspected y:` • ! J� - <br />Facility Address: a3 <br />A #: <br />I certify underpenalty of law that: <br />.I have corrected, the vioiations specified in the Inspection Report from the above-mentioned <br />inspection date, <br />2. T have personally eXamined the following ,do <br />ubmitted as FACTS VIOLATION and I believe the information to be hue, acc ate,and caompletOf e.. compliance Ff�R <br />._Photos Paperwork <br />-Statement <br />3. T am authorized to subm t this certification on behalf of the Respondent. <br />4. T ant aware that there are significant penalties for submitting false laformati <br />on" including the <br />Possibility of a fine and/or imptisomnent for knawn violations. (RSC 25191) <br />Mame: c.1 i, 42 <br />E.I:ID 22-02-005 P ev 12-04 <br />Title: <br />Date: <br />L <br />