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i <br /> i <br /> 002454 <br /> SAN JOAQUIN COUNTY <br /> ENVRONMENTAL HEALTH DEFT HENT <br /> 600 Fast Main Street, Stockton, CA02-3029 <br /> TaleQ�rrro: (209 468-3424 Fax:(209 488-3433 a6: www. jaov.otnfelid <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MLNPR violations noted in, the `Notice to Comply" in the attsi ped Inspection Report must be <br /> corrected within 3i3days of receipt of this inspection. This certifi tion form must be submitted to the <br /> Environmental Health Department (EHD) address at the top ofthi forrri within 30 days of receipt of the <br /> Inspection Report <br /> All cqrrections to other viviatiotts noted 'n the attached Inspectioneport (IR) or Continuation Form, or <br /> disputes to any violations, are tc be su,*)mitted using this certifiosti n and retumed to EHD within 30 days <br /> unless otherwise specified in the inspection Report. <br /> Note: All EHL staff time associated with falling to compi by the above rioted dates will be <br /> billed at the current hourly rate. <br /> For this certification to be Complete the ope ator of the site roust include: <br /> • A statement docurrenling 16.!hat corrective actions were taken or will be taken for each violation <br /> • Copies of sample results/manif stsltraining records/other ap ropriate paperwork, and/or photos <br /> verifying corrections <br /> Operator's certification <br /> r - � o� � Inwe ted 8 /�Its l � <br /> Inspection Date:j/- 1___ we y: l i <br /> Facility Address:__LCrt,t,r� -._a l.l. .'3 EPA I - - ---- - ------ <br /> i <br /> I certify under penalty of l,aw that, <br /> 1. 1 have corrected the violations specified in the Inspection iReport from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation, ?,-rtsittecf as proof of compliance FOR <br /> EACH VIOLATION and i t)+eiieve the-inform ion to be true. accurate, and complete ' <br /> PhotosPaperwork L'_ Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4 i am aware tl`.at there are significant penalties for submitt 9 false information, including the I <br /> possibility of a fine al.dloi imprisonment for known violoti s. (HSC 25191) <br /> ` <br /> Nam <br /> e° _ <br /> Signature <br /> EHD 22-02.005 Rev 08108 <br />