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llityzl-fl <br />I <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street Stockton, CA 95202-3029 <br />.............. i , . 1 111 <br />, % AML t�Lgj �Lrvf <br />0:4101MINCINCL7 11111J11]? i l�� <br />r4:1144A i I ill <br />1 0 1 a 0 11, 1 t 0 1 - *101114111111 VTI�� <br />I111-20MV77K inglacau "AII&A 67W-111*1 I fill (710 • <br />nTiroul-nenial AUMYfr1UPUfWffUMffr4# <br />Inspection Rep(•rt. <br />u1splies io OR <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 current hourly rate. <br />' I <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 resultstmanifestattraining recordstother appropriate paperwork, and/or photos <br />verifying corrections <br />Inspection Date: -2- 7 61 _7 <br />Facility Address:256,6 <br />Inspected By: At <br />EPA 11D#: <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />*I 1 *10 1 E <br />Ell ow .11 <br />HIA7 I I 16,11 RFI U01 I 1LO'loig] I OM <br />--.----,,—Photos Paperwork Statement <br />ff T.177N r, =W 1 MIE711117-711 071 , =#t * M-0 <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 />Narne- Title:5JA!r-44, <br />Date- <br />EHD 22-02-005 Rev 08108 <br />