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SAN JOAQUIN COUNTY ]ENVIRONMENTAL HLAL ni DEPARTMENT 304 East Weber Avenue, 3r1 Floor,Stockton, CA 95202-2708 TelephlOne;(209)468-3420 ax.(209)468-3433 Web: 1%nyxv-sjgov.org/ehd RETU TO COMPLIANCE CERTIFICATION Any MINOR violations not d in the"Notice to Comply'' in the attached inspection report must be c.orTemerl within 30 days of eceipt of this inspection. This certification form must be submitted to the Environmental health Depa ent (EHD) address at the top of this form within 35 days of receipt of the inspection report. All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations, are to be submitted using this certification and returned to EHD within 60 days unless otherwise specified i the IR. For this certificati n to be complete the operator of the site must include: • A statement docum ting what corrective actions were taken or will be taken for each violation • Copies of sample regults/manifests/training records/other appropriate paperwork, and/or photos verifying correction • Operator's certifica on Inspection Date: I 2 Inspected By:W 1�-ken e, i-f��2:7 Facility Address: EPA ID#: Cil- 00o z3 7 334 I certify under penalty o law that: 1, I have corrected the ijolations specified in the Inspection Report from the above-mentioned inspection date. 2. I have personally exannined the following documentation submitted as proof of compliance FOR EACH VIOLATIO and I believe the information to be tnie, accurate, and complete- Photos e/ Paperwork �Statement 3. 1 am autho ' ed to s mit this certification on behalf of the Respondent. 4. I am aware at there are significant penalties for submitting false information, including the possibility of a fine d/or imprisonment for known violations. (FISC 25191) Dame: rww r,.s Wr ?t4-%2 Title; ok-Lj� Signature: _ Date: I .?- I y-,-7 EHD 22-02-005 Rev 2-04 Z0 39Va 3,AA3S>1If,'Di Z9aZZ686aZ Zb :60 100Z/8T/Zi