Laserfiche WebLink
�rnirrn ,.:.,...,.raro*.x.—., yr..�.o...,..---.... rim..q?a:. ra';;...x:+pNn,�✓�,Ytso `HG3''1�lltd) <br /> � a <br /> SAW JOAQUINC.QY TY;.>;:- '�(dl �l.• <br /> ENVIRONMENTAL HEALTHQ0AR7M Rt'G,; <br /> 600 East'Maln Street, Stdck1oh;_6CA85202.30214 <br /> ' t': Tefephono:(208)488-3420 Fax:(209)488-3433 Walt:www.siggy:org/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached.inspectfon Report must be A. . <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmentamealth Department (EHD) address at the top of this forrrf within 30 days of receipt of the <br /> y...r.. <br /> Inspection Report. ,.k . <br /> All corrections to other violations 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 3(T days. { %> <br /> IR taS. <br /> unleseatherwisespecified in the Inspection Report: r: <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will bq.:1 <br /> billed at the current hourly rate. <br /> For this Certification to be COt'1<Iplete the operator of the site must include: <br /> • A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> Verifying corrections ,•• <br /> • <br /> Operator's certification r't <br /> Inspection Date: •41—/g- za/O Inspe Al'pf) <br /> Facility Address: P 10#1: C <br /> r .7 I �' •ac's'• ., y'� <br /> I certify under peitalty of law that t / ©? <br /> 1. I have corrected the violations specified in the spection Reportfrom the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined 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_j�Statement i <br /> t . <br /> 3 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penalties for submitting false information, inclyding the . <br /> possibility of a fine and/or imprisonme t for known violations. (HSC 25191) <br /> Name: V 7rY(/ !,g4 Tjtie: -)D,4et-,o7e2. <br /> ie: <br /> Date: <br /> Sign <br /> ' 'ro <br />