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0 NEW WEST PETROLEM Fax Aug 13 2009 10:33am P022/022 <br /> u <br /> SAN JOAQUIN COUNTY <br /> <° ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street; Stockton, CA 352023029 <br /> Teter':<n?,;:(209)468-3420 Fax:(209)468-3433 Kleb:w�vvv.s Io\.(rkehd <br /> RETURN TO COMPLIANCECERTIFICATION <br /> Any MINOR 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 t:e submitted to the <br /> Environmental Wealth Department(EHE}) address at the top of this form v<<ithin 3C}e ays of receipt of the <br /> Inspection Report. <br /> All corrections to other violations noted in the attached Inspection Deport (IR)or Continuation Form, or <br /> disputes to any violations, are to be submitted using this certification and returnee 'o EHD within 30 da s <br /> unless otherwise specified in the Inspection Report, <br /> Note: All EHD staff time associated writh failing to comply by the abovc noted dat~ee will be <br /> billed at the current hourly rats. <br /> For this certification to be Complete the operator of the site Y ust include: <br /> * A statement documenting what corrective actions were taken or will be taken I or each violation <br /> * Copies of sample results/manifests/training records/other appropriate paperm,.rk, and/or photos <br /> verifying corrections <br /> e Operator's certification <br /> Inspection Date: _�x..c. Inspected By.,T <br /> Facility Address: �,q_31 EPA ID#: `A L00i:�, i <br /> I certify under penalty of lain!that: <br /> 1. l have corrected the violations specified in the Inspection Report from the �)ove-mentioned ` <br /> inspection date. <br /> 2, l have personally examined the:following documentation submitted as prop! of compliance FOR <br /> EACH VIOLATION and I believe the:information'to be true, accurate, and ,,)mplete: <br /> Photos Paperwork Statemert <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 informat r n, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191; <br /> Name: c ,:l A e-rc Title: <br /> ? �/ <br /> Signature: Date: <br /> EKE)22.02-005 R@v 08106 <br />