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JAf4-18-2009 20:38 FROM: + T0:4683433 P.2/3 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Strut,Stoektm CA 93202.3029 Tdeph"v(209)468-3420 Fax:(209)468-3433 Web.,www jjSa3-S2Wehd RETURN TO COMPLIANCE CERTIFICATION Any h-0$violations noted in the"Notice to Comply" in the attached Inspection Report must be corrected within 30 days of receipt of this jnspection. This certification forrn must be submitted to the Environmental Heaton Department(EHD) address at the top of this form within 35 days of receipt of the Inspection Report. All corrections to_othrr violations noted in the attached Inspection Report(1R) or Continuation Form, or disputes to any violations, are to be submitted using this certification and returned to EHD WiIWA 30 daYs unless otherwise specified in the Inspection Report. Note: All BHA staff time associated with failing to comply by the above noted data wal be billed at the current hourty rate. For this certification t0 be COmplete the operator of tine site must iaclude: I is A statement documenting what corrective actions were taken or will be taken for each violation o Copies of sample results/maniftsts/training records/other appropriate paperwork, and/or photos verifying corrections Operator's certification Inspection Date:_ � r Inspected By: Facility Address: 4 9 a, cd.�.o,�r� [ EPA iD#: C:4 0 0171 U 164, �S-ToC 6czaWJ, I certify under penalty of law that: 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate,and complete: Photos�TPaperwork Statement 3. I am authorized to submit this certification on behalf of the Respondent. 4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or imprisonment for known violations. (HSC 25191) Name. `-el e''t f7 y odJ T itic:_ o c,J rl 64— Signature: 4Si ature: Date: ell 7 t EHD 22.02-005 Rev 11/07