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SAN JOAQUIN COUNTY <br />ENvIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />jt, I 1• • 1 1• •€�,&AZZI�a Wig <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violdtiofis noted in the "Notice to Comply" in the attached inspection report must be <br />corrected within 30 days of receipt of this inspection. This certification form must be submitted to the, <br />Environmental Health Department (EHD) address at the top of this form 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 />For this certification to be complete the operator of the site must include: <br />0 A statement documenting what corrective actions were taken or will be taken for each violati• <br />* Copies of sample results/manifests/training records/other appropriate paperwork, and/or phot• <br />verifying corrections <br />Operator's certification <br />E• r. <br />W-Mamirsom <br />WMEM <br />W99m; <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />3-M =I I IM I'll I =I I to I wis <br />'IFTMINUMIRT-11R. - - a It <br />Wail MMA L91W_1VV LON 731ousagoorillcus to <br />F`�hotos Paperwork Stateme�j_ <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />Name: Title: <br />Signature: Date: <br />EHD 22-02-005 Rev 05/07 <br />