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unless otherwise specified in the IR. <br /> Ls / <br /> For this certification tO be complete 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 /> • Operator's certification <br /> Inspection Date: b 5 Inspected By:� <br /> Facility Address: 7o-7 • YD&2mj-& EPA ID#: (fAK00000 7613 <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I 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 Statement <br /> 3. lam authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: _ /�/yvc6e/U1t(F�e Title: 6�, )P_e>z <br /> Signature: r/G Date: �— <br /> EHD 22-02-005 Rev 05/07 <br />