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09/25/2009 13:13 2094749151 HAMMER. I5 ARCO PAGE 01/16 <br /> SANJOAQUIN COUNTY' ." ' <br /> ENVIRONMENTALHEALFH DEPART..MENT <br /> 600 East Main Street,Stockton, CA 95202-3029 <br /> - Telephone:(209)468-3420 Fax:(209),4W3433 Web:www,sigov.or /,g ehd <br /> �, n <br /> RETURN TO COMPLIANCE CERTIFICATIC ,.? ro <br /> AnyINl NOR violations noted in the'Notice to Comply" in the attached Inspection Rep t <br /> corrected within 30 days of receipt of this inspection. This certification forrn.must be su .to e <br /> Environmental Health Department(EHD) address at the top of this form within 30 days pt o 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 otherwise specified 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 cufrent-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 recordslother appropriate paperwork, and/or photos <br /> verifying corrections <br /> . Cierator's certification <br /> Inspection Date: �?l l� Inspected BY: Cmc <br /> nr" <br /> Facility Address: r-( .•�.® EPA I :�Ai �/�®�"? _ <br /> I certify under penalty of law that: <br /> 1. I 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 t believe the information to be true, accurate, and complete: <br /> Photos Paperwork —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: <br /> -Signature: Dater <br /> AHD 22-02-M Rev 08/08 <br />