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JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />6 z 0 <br />(27 W111A," <br />Inspection Report. <br />0111�H=Iln- N 04WIM, <br />[01weilij im (*1F�]flTATJT#1r_14 <br />Note: All EHO 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 violatio <br />• Copies of sample results/manifests/training recordslother appropriate paperwork, and/or pho )] <br />t <br />verifying corrections <br />e17) <br />Inspection Date: _27 7 <br />Facility Add s:2`6 765��' <br />Inspected By:A <br />EPA ID#: <br />A -2 <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />0 49 11 0 . 2 1 <br />R41111#117V <br />IIIIIIIIII1101ffel: WILOWTAIL410 1 141011011101:10 NIF101-01FRIM-1114 F� <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 />ki 1 j - /7 <br />Name: tQ0L C) Title:5) <br />Date- <br />EHD 22-02-006 Rev 08/08 <br />