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Cal-EPA DEPARTMENT OF TOXIC SU STANCES CONTROL Arnold Schwerzenegger,Governor <br /> SAN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 000 E MAIN 3T, <br /> STOCKTON,CA 95202-3029 <br /> TIERED PERAUTTING <br /> CERTIFICATION OF RETURN"CONRUANCE <br /> For Permit by Rale,Conditionally Authorized,and Conditionally Exempt Notiflers <br /> In the matter of the Violation cited on: 1 l ja <br /> Located at: ' Au S.4 (facility address) <br /> As Identified in the Inspection Report dated <br /> Conducted by: __(ageucy(s)) <br /> I certify under penalty of law that: s <br /> i. Respondent has corrected the violations specified in the notice of violation cited <br /> above. <br /> 2. I have personally examined any documentation attached to the certification to <br /> establish that the violations have been corrected. <br /> 3. Based on my examination of the attached documentation and inquiry of the <br /> Individuals who prepared or obtained it,I believe that the information Is true, <br /> accurate,and complete. <br /> 4. I am authorized to file this certification on behalf of the Respondeat. <br /> 5. I am aware that there are significant penalties for submitting false information, <br /> Including the possibility of fine and Imprisonment for linowing violations. <br /> Name(Print or Type) Title <br /> store _Date Signed <br /> company Name EPA M.Number <br /> Revised 06/08/07 <br /> 11/08/2010 5 : 38PM (GMT-05:00) <br />