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' :■:?c 11 17 02:43p p.1 <br /> ■ <br /> Ernvironnm, anta-A H,6891;6 C." i <br /> ,S 1S, N J <br /> 0. ' � i id <br /> DEC <br /> ,C��M1MENr'�N <br /> r� kk t Nr <br /> RETURN TO COMPLIANCE CERTIFICATION RFs <br /> Any MINOR violations noted in the"Notice to Comply'in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD) address <br /> the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report (I R) or Continuation Form, or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate. <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 recordslother appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: November 07,_21017 Inspected By: CII-SAP RiUVALCP1BP, <br /> Facility Address: 31 15 S EL DORADO _`-T, i-RENCH Ca,MP CERS ID: 10180520 <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection 9eport from the above-mentioned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and complete: <br /> Photos Paperwork Statement <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, including the possibility of a fine <br /> and/or imprisonment for known violations- (HSC 25191) <br /> Name. Title: <br /> Sionature: Date: <br /> g <br /> � ,��. ora saa Z 1s �s7, � � nC � V�_ <br /> � 1 <br /> 'lI - K< a4 <br /> ?R OS.?7175 <br /> FAO000I1(:) <br /> C*= <br />