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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />RETURN TO COMPLIANCE CERTIF.ICATION <br />Any MINOR violations noted in the "Notice to Comply" in the attached -Inspection Report -must be <br />corrected within 30 da of receipt of this inspection. This. certificabon form -must be submitted to the <br />�Environmental Health Department (EHD) address at the top of this form within 30 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 submitte d using this certification and returned to EHD within 30 days <br />unless otherwise specified- in -the Inspection Report. -- . ..... <br />Note: All EH1D staff time associated with failing to comply by the above noted dates will be <br />billed at the current hourly rate-. <br />For this cercation to be completethe operator- of the site must include: <br />• A statement documenting what corrective actions were taken or wi ' 11 ' be , taken for each violation <br />• Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br />verifying corrections <br />I 111MOTTWUll! r_ <br />MT7.= <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />Photos Paperwork Statemen) <br />4. 1 am aware that there are significant penalties for submitting false information, including thIt <br />possibility of a fine and/or imprisonment for known violations. (HSC, 25191) <br />Name: � I . 11 i <br />Signature: <br />EHD 22-02-005 Rev 08/08 <br />Title: <br />