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2098263893 ENGINEERING DEPT. 1 :51 a.m. 09-13-2010 2/2 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone. (209)468-3420 Fax. (209)468-3433 Web:www.sjgov.oM/_ehd <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 inspbction. 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, Pre to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specifiedin the Inspection Report. <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be <br /> bill f fed at the current hourly rate of$115 (beginning 8/11/09 the hourly rate will be$122). <br /> For this cwtification to be completet1he operator of the site must include: <br /> • A statement doommenting what corrective actions were taken OF will be t6ken for each violation <br /> • Copies of sample results/manifests/training records/othe*r app* ropriater paperwork, and/or photos <br /> verifying corrections <br /> • Operator"s certification <br /> Inspection Date: Q Inspected By: <br /> Facility Address: /2!2r, EPA ID : <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 persorially-jexamined 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 V 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: r/ —Title:— /Xfel <br /> Signature: Date: <br /> 4 <br /> EHD 2202-005 Rev 06/09 <br />