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05/21/2008 00:25 503524 RUTH HA - BP PAGE 03/03 <br /> SAN JOAQUIN CO UNTV <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Sheet,Stockton,CA 91202-3029 <br /> 7ele�lmrr�:(209)468-3420 arra:(209)469-3433 1Vvh- www.,n gRy.ore/elld <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Noti.cc to Comply"in the attached Inspection Repoli must be <br /> corrected within.30 da s of receipt of this inspection. This certification form must l)c submitted to the <br /> Environmental Health Department(EHD)address at the top of this forin within 35 days of roc:e;ipt of the <br /> Inspection Report. <br /> All corrections to other violations rioted in the attached Inspection Deport(TR)or Continuation Forth, or <br /> disputes to any violations, are to be subrnitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the inspection Report. <br /> Note: All EHD staff time associa$ad with failing to comply by the above noted dates-wilt be frilled at <br /> the current hourly rate(5911). <br /> For this certification to be complete the operator of die site 117Ust include: <br /> * A statement documenting what corrective actions were taken or will be taken for %.itch violation <br /> er Copies of sample results/manifests/trai.ning records/other appropriate paperwork.and/or photos <br /> verifying corrections <br /> Operator's certification <br /> Inspection Date: jG Inspected <br /> Facility Address:_/ EPA ID#: C'l��. G'D 2.3-77 17. <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mclitroned <br /> inspection date. <br /> 2. l have personally examined the following documentation submitted as proof af compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> Pl10ttD5 K_Paperwork—........-Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4, 1 am aware that there are significant penalties for submitting false information, including tlic <br /> possibility of a fine and/or imprisonment for known violations. (HSC 2519 1)// <br /> Name: ! Title: <br /> --�- f <br /> Signature: Date' <br /> EHD 22-02-005 Rev IT/07 <br />