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02/24/2006 13:05 2098328078 BONFARE 35 PAGE 01 <br />SAN JOAQUIN COUN'1'i' <br />h fy <br />F,NVIRONMENTAL HEALTH P,1>,TMEYT <br />X; I/ P 01 <br />304 East Weber Avenue, P Floor, St0C1;1::'n, CA 9:=.>_02-2708 <br />Telephone. (209) 469-342-0 Fax: (209) 469-391 Web: wYaM&qv.or <br />TURN Tehd <br />, _ _SL_— <br />OMPI,IANCI�'ii'14ER9["IFICATION <br />RIEO C <br />Any MINOR violations noted in the "Notice to C1:)mPly,:! attachcd inspection rePoTl: rnusd <br />eI -tt-spect onThis 4� icatica form must be sut nittto the <br />corrected within jQ_AM of receipt of this in <br />the top 1*t(iis farim within 35 daysc receipt Environmental Health Department (E1 -ID) address at <br />inspection report. <br />All corrections to other violations noted in the attached Inspi:.—t1on Report (IR) oed to EH ) r Continatwithiion Fn 60 d?y <br />orm, or <br />disputes to any violations, are to be submitted using this cell 1,-tcation,iind return <br />unless otherwise specified in the IR. <br />For this certification to be complete the c, 1 irator of -1he site must inclw <br />® Astatement documenting what corrective actions v, j:'e, taken or will be taken fo each violation <br />® Copies of sample results/manifests/traini.ng record,,;; ther app-Lopriate paperworl: and/or photos <br />verifying corrections <br />9 Operator's certification <br />Inspection Date'. <br />Facility Adch-ess, <br />I certify under penalty of law that: <br />Irispecti!d By;: c <br />E,PA 11"W: <br />I have corrected the violations specified in the 1nF;-):1'%ion R-Vort from the abw ,-mentioned <br />inspection date. <br />2. 1 have personally examined the following docurnl:,j submitted as proof 0 compliance FOR <br />EACH VIOLATION and I believe the informatic lo be tri o, ac urate, and co iplete: <br />Photos Papc : .,ork Statement <br />3. 1 am authorized to submit this certification on be i Wof the Respondent. <br />4. 1 am aware that there are significant penalties fbi LbMittlr:�:,, false information; including the <br />possibility of a fine and/or imprisonment for kn(j .:t o,iolatj. -.Ins. (HSC 2519 1) <br />Tith:.,: <br />" <br />Name: <br />7 : <br />20 SignatuDatc <br />re: . ..... <br />ttu <br />