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MAY-13-2008 04:35P FROM: TO:4683433 P.18 <br /> U <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.*Mn8&.sgoy.o_r9Zehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any PdE__OR violations noted in the"Notice to Comply"in the attached Inspection Report must be <br /> corrected within 30ays of receipt of this inspection. This certification 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 /> All carrections to otherviolationsnoted 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 baled at <br /> the current hourly rate($98). <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--ach violation <br /> • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> I ��- <br /> Inspection Date: g- t% 0,;Z Inspected By: <br /> ar, Tv__� <br /> Facility Address:- EPA ID#:CA L- C,C?C-2-2.3 S"37 <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 personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate,and cegete: <br /> (3) <br /> 1,Wl� <br /> Photos Paperwork L,,�Statement VA <br /> +AL-0- ()I04W Sit4hue—ar �3, _Cj,�,tck • <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. Crrvq %—op. ort R01V <br /> iva 0. <br /> 4. 1 am aware that there are significant penalties for submitting false information, includinR,Vthe <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> YY <br /> Name: Title: <br /> ry <br /> Signature: Date: <br /> FHT) 27-02-005 Rev 11/07 <br />