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01/10/2006 16:37 9163928768 T&R ELECTRIC PAGE 02 <br />6 <br />SAN JOAQt,1tPi' COUN'T'Y <br />P-NvTRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3`4 Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fav: (209) 468-3433 Web: ® .sieov.org/ehd <br />Any IM I N'O violations noted in the "Notice to Comply" in the attached inspection, report must be <br />corrected within 30 da s of receipt of this inspection. This certification form must be submitted to the <br />Environmental Health Department (EMD) address at the top of this forth within 35 days of receipt of the <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 60 days <br />unless otherwise specified in the IR. <br />a 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 />inspectionDate: Inspected By: Xe4lh 4& <br />Facility Address: -'ANO E, M <br />I certify under penalty of law that: <br />1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />2. I have personally examined the following documentation subrnitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be time, accurate, and complete: <br />Photos Paperwork <br />3. I am authorized to submit this certification on behalf of the Respondent. <br />4. I 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: C o?rt 'Title: A C tC✓ �a �t✓ <br />ic�a��i�.�►I��� ��► t <br />