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002454 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telgp:�one:(209)468-3420 Fax.(209)408-3433 Web:www.siaov.om/ehd <br /> TURN TO COMPLIANCE E TIFI I N <br /> Any MINO violations 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 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 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 <br /> billed at the current hourly rate. I <br /> For this Certification to be Complet the operator of the site must include: <br /> • A statement documenting what corrective actions were taken or will be taken for each violation I <br /> • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date. —/ Z — d t Inspected By: 41 <br /> s C'RCRQ4► <br /> Facility Address: 172-1 a. CAw4bko-Ar N. EPA 1 : 1- 660 O'fS'9,q0 <br /> 4a G , C i <br /> I certify under penalty of law that: j <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the-information•to be true, accurate, and complete: <br /> Photos 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 the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: ®` V = Title: ®►2Kc fit!✓. <br /> Signature. Date- - 3 - 0 cl <br /> t <br /> EHD 22-02-005 Rev 08/08 <br />