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0 SANJOAQUINCOUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Sfte4 Stoclaon, CA 95202-3029 <br />1, jj 11 - uuwh <br />1 111 Di JHWINEI , WS]DR-4111 1, - I <br />Inspection Report. <br />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br />.J - <br />unless otherwise specified in the Inspection Report. <br />the current hourly rate ($105). <br />q <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 />Inspection Date:—':e- 2 C - 0 9� Inspected <br />Facility Address: / Y Z!2 & <br />:- �, EPA IID#: <br />I I have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, accurate, and complete: <br />Photos _zPaperwork Statement <br />11111111111: 11 ; <br />� I rliiiliillm�l 1� <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:— Title: c <br />I -t 1 19, 161 Plat M1 it i's =0 I <br />