Laserfiche WebLink
0 rry . 4�:wF •;r <br />d :4:' <br />��`�" �,;J;di•`` <br />di t <br />.; d ILd W1• <br />RETURN To COMk0L1A,NCE CER TIFICA 11014 <br />Any MING violations noted in the "Notice to Comply' in the attached Inspection Report must be cor acted witj7in 30 days of <br />receipt of this inspection. This Certification form must be submitted to the Environmental Health Department (EHD) address at <br />the bottom of this form within 30 days of receipt of the Inspection Report, HSG 25404,1.2(c)(1) <br />All corrections to other violations noted in the attached inspection Report (IR) or Continuation Form, or disputes to any <br />violations, are to be submitted using this certificatlon and returned to EHD wil , in 30 da K unless otherwise specified in the <br />Inspection Report, HSC 25185(c)(3) <br />Note: All EHD staff #lime assoc14mt0d with #ailing to comply by the above noted dates will be billed <br />at the current hourly rate. <br />For �hiS t;�r�ifiCatign tU �� pomp#eta, 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 verifying corrections <br />Operator's certification <br />inspection Cate: February 13, 202(J <br />Facility Address: t ���� � HARIrAN FtQ, LAiHROP <br />I certify under penalty of law that; <br />Inspected_PAUL NS�l <br />CERA ID: 1a18054�1 <br />1. E have corrected the violations specified In the Inspection Report from the above-mentioned inspection date, <br />2. f have pal's❑Wally examined the following documentation submitted <br />as proof of compliance FOR EACH VIOLATION <br />and I believe the information to be true, accurate, and co►tiplete: <br />Photos <br />Paperwork Statement <br />3, I am authorized tri submit this rectification on behalf of the Respondent. <br />4. I am aware that there are significant penalties for submitting false information, including the possibility of a fine <br />and/or impris❑nmer�t for known violations. (HSC 25191) <br />Name: <br />Title: <br />�ignat <br />t ' ` � <br />Date: <br />, <br />MAH 1122020 <br />ENVIRONMFN7gL <br />ENVIRONMFN7gL <br />