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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPART <br />NT <br />600 East Main Street, Stockton, CA 95110 <br />-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 W b <br />i <br />www.s ov. <br />r lehd <br />i <br />i <br />RETURN TO COMPLIANCE CE <br />IFICA <br />ION <br />Any MINOR violations noted in the 'Notice to Comply" in the attachec <br />Inspection <br />Report must be <br />corrected within 30 days of receipt of this inspection. This certificatio <br />form must <br />be submitted to the <br />Environmental Health Department (EHD) address at the top of this o <br />m within 3 <br />days of receipt of the <br />Inspection Report. <br />All corrections to other violations noted in the attached Inspectiona <br />ort (1R) or <br />ontinuation Form, or <br />disputes to any violations, are to be submitted using this certlficatlotInd <br />returne <br />to EHD within 30 days <br />unless otherwise specified in the Inspection Report. 1 <br />Note: All END staff time associated with failing to comply] k <br />y the abore <br />noted dates will be <br />billed at the current hourly rate. <br />For this certification to be complete the operatc <br />r of the site <br />must include: <br />. A statement documenting what corrective actions were taken or <br />vill be take <br />for each violation <br />• Copies of sample results/manifests/training recordslother app <br />riate papa <br />ork, and/or photos <br />verifying corrections 1 <br />• Operator's certification <br />Inspection Date: 2- Z Z- pcj Inspect <br />By: <br />/ C C <br />�y <br />:Facility Address:1 Z� /l. � rCc Cc��w�EPA IDj# <br />j <br />I certify under penalty of law that: <br />1. 1 have corrected the violations specified in the Inspection Rl <br />rt from th <br />above-mentioned <br />inspection date. <br />2, I have personally examined the following documentation sup itted asp of of complianoe FOR <br />EACH VIOLATION and I believe the information to be true, Ila urate, an complete: <br />Photos Paperwork i StatemE nt <br />3. 1 am authorized to submit this certification on behalf of the <br />4. Jam aware that there are significant penalties for submittinof Ise. infor tion, including the <br />possibilityof fine and/or imprisonment for known violation' . (HSC 251 1) <br />Name: <br />itle: <br />aU-- C rel b Lt S'( <br />Signature: Date: 141- / 6 <br />