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SANJOAQUIN <br />ENVIRONMENTAL <br />.00 East Main Street,Stockton, <br />Tatephono.*19<:: (204468-U33 rw •• •e r <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any IWINOR violations noted in the 'NotiqVOW L Comply" in the attached InspecUory Report must be <br />corrected within 30 days of receipt of this inspecUon. This cedification forrkmyst be submitted to the <br />Environmental Health Department (EHD) address at the top of this form within 30 days of receipt of the <br />InspectionReport. <br />-otherwiser &oIM2q_n_s noted in the aftqched inspe0lon Report (111) or Continuation Form, or <br />disputes to any violations, are to -be subMftted usIng-thle certification and returned to 151-10)ftin 30 dgys <br />unless .: <br />'4ote: All E1HD staff time sissociiated with Wiling to cbmply by the' above noted -dates Will b1ze, <br />billed at the current hourly rate. <br />oe this certification. to be complete the operator of ." afte must Include: . <br />OocumerMng otrectivq actionswere - or be ♦ ea�h viol4on <br />0 Copies of sample resuKWmqnIfestsWning records/d I ther appropriate paperwork, antgor Ootos <br />,;., • corrections <br />••w _.•, _ COM*1961T <br />care.. <br />Inspection Date:• • r1 <br />Inspected . • - <br />Facility • <br />i / <br />y, <br />A i y� <br />under1 certify penalty of <br />•1 r <br />corrected - violaflons ipeclW In the Inspebtion_•r •m the above-mentio <br />ned <br />inspection <br />personally examined the following •r • • :• • •• •compliance <br />EACH VIOLATION • • • • r beaccurate, • complete: •W <br />-Photos• r <br />• c• '• •MU= M717• • • • -'� •• • <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 />fS �42t/4'r� Title: c _ A1y. •�i/t s <br />EHO 22-02-M Rev 08/0® <br />