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Cal-EPA DEPARTMENT OF TOXIC SU TANCES CONTROL Edmund G.Brown,Jr.,Governor <br /> SAN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY o. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN ST. <br /> STOCKTON, CA 95202-3029 <br /> TIERED PERMITTING <br /> CERTIFICATION OF RETURN TO COMPLIANCE <br /> For Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers <br /> In the matter of the Violation cited on : <br /> Located at: (facility address) <br /> As Identified in the Inspection Report dated <br /> Conducted by : (agency(s)) <br /> I certify under penalty of law that: <br /> 1. Respondent has corrected the violations specified in the notice of violation cited <br /> above. <br /> 2. I have personally examined any documentation attached to the certification to <br /> establish that the violations have been corrected. <br /> 3. Based on my examination of the attached documentation and inquiry of the <br /> individuals who prepared or obtained it, I believe that the information is true, <br /> accurate, and complete. <br /> 4. I am authorized to file this certification on behalf of the Respondent. <br /> 5. I am aware that there are significant penalties for submitting false information, <br /> including the possibility of fine and imprisonment for knowing violations. <br /> Name (Print or Type) Title <br /> Signature Date Signed <br /> Company Name EPA ID. Number <br /> Revised 01/24/2011 <br />