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FROM FAX NO. Mar. 09 2009 03:46PM P1 <br /> '. <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telep one:(209)468-3420 Fax:(209)468-3433 Web:www.sieov.orK/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations no ed in the"Notice to Comply" in the attached Inspection Report must be <br /> correc,tQd within 3davs o receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Dep rtment(EHD) address at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All corrections to other vio ations 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 billed at <br /> the current hourl!k rate. <br /> For this cextifieati ri to be complete the operator of the site must-include: <br /> e A statement docu enting what corrective actions were taken or will be taken for each violation <br /> • Copies of sample r ults/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying correctio s <br /> • Operator's certification <br /> Inspection Date: 01 _ _,0 9, Inspected By: /yl i e h g ll e 14^ <br /> Facility Address: 5_/S�W //1" -rgGY EPA ID#: CAL ZQPJ 22-17 6 <br /> I certify under enalty�f law that: <br /> 1. I have corn eted th�violations specified in the Inspection Report from the above-mentioned <br /> inspection ate. <br /> 2. 1 have personally e�amined 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 /> V <br /> 3. I am autho ' ed to ubmit this certification on behalf of the Respondent. <br /> 4. I am aware that the a are significant penalties for submitting false information, including the <br /> possibility 6f a fin and/or imprisonment for known violations- (HSC 25191) <br /> Name: -8 S l Title:? <br /> Signature: Date: 3 9 ` O <br /> >~I-m a Pv 1 1/071 <br />