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07/19/2011 14:47 2098585gLG TWO GUYS FOOD FULL PAGE 01/02 <br />SAN JOAQM C®[nM <br />ENVIILONMLNTAL MALTH DEPARTMENT <br />60•E. MAin St, S=kton, CA, 95202-3029 3� <br />Telephone: (209) 468-3420 F4cr (209) 468-3433 Web: vuwvuww.s.13� .o hd <br />JUL 19 2011 <br />RETURNTO COMPLLkNCE CERT CATTgP <br />Any M, INOI2 violations noted an the "Notice to Comply" in the attached Inspection R rf im st be `y <br />corrected. within 30 da of receipt of this inspection. This certification form must be submitted to the <br />nvironrmental Health ]Department (EHD) address at the top of this form within 35 days of receipt of the <br />l <br />Inspection Report. <br />All 0.0 On$ to other violations noted in the attached Inspection Report or Continuation Forni, or <br />disputes.to any violations, are to be submitted using this certification and returned to EHD within 30 days <br />unless otherwise specified in the inspection Report. <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at <br />the current hourly rate ($122). <br />F®f .ffiis certification t0 be c®mplete the operator of the site must include: <br />• A statement documenting what corrective actions were taken or will be taken for each violation <br />• Copies of sample results/manifests/twining-record-9/other appropriate paperwork, and/or photos <br />verifying corrections <br />• Operator's certification <br />(inspection batej --ik— �( <br />Facility Address: i=ii= 1�A ti <br />I certify under penalty of law that: <br />Inspected Byj rM��M <br />1. 1 have corrected the violations specify in the Inspection Report -from. the above-Wentioned <br />inspection date. <br />2. I have personally examined the following documentation submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, acte, and complete: <br />Photos _ Paperwork :Statement <br />3. I 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 the <br />possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />Name: Title: - <br />Date-. / —t B -lj <br />