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0 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.o[g/ehd <br />RETURN TO COMPLIANCE CERTIFICATION <br />rMlIF511,11[e] 0 . 0 1 0 - 0 a I I �-G � 1-Tr4rF.11 f; to] 217ro I ff tne A 0-I 1 0 a I I 0 - <br />W-gign 0 <br />I <br />of RWIN ea I op 0 <br />ne t1 Inis <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. I <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be <br />billed at the current hourly rate. <br />For, this certification 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 results/manifests/training records/other appropriate paperwork, and/or photos <br />verifying corrections <br />• Operator's certification <br />lrtr-rp��� <br />Ffr-Tff OUT= <br />--T1q Md. <br />Inspected By: <br />[49-1111 <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentiorri4t <br />inspection date. <br />:Fffel ' WA I*] WTV 9 [010 W; I a 5 11 U mr-Try-14 a [41 alm asin 1416111stonsizziffil - <br />Photos 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: I Title: <br />�2111111 <br />EHD 22-02-005 Rev 10109 <br />Date: <br />