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06125/2012 11:01 2093344684 #4297 P.001 /003 <br /> 00 a <br /> M OWNTY <br /> EwRUNMENTAE.HEALTH DEPARTMEfd7' <br /> 6{10. t,M'a'in.. . +�A 95202-304. J i <br /> T" `Tone.(2d9)...... -3420 ) -omtow <br /> RETURN TO COMPUANCE CERTIFICATION <br /> Any MINI violations Hated in the-Notice to comw in the attached Inspection Report must be <br /> cgrr�t�hin 30 dans of °pt of this inspection. This on frit must be subm #o to <br /> Environmental Heap (EHD)adds at the top of this in 30 days of ofthe <br /> Inspection Report., <br /> Ali coaRmotherviolgM noted in the attached inspection Report(IR)or Continuation Form, or <br /> disputes to any violatiOnS,are to be submitted using ion and to EHD within 30 dw <br /> u S in the inspection Report. <br /> Note: All EHD staff firno associatedwiling to comply by ft above noted dato will be <br /> bi!led at the cunont houdy rate. ; <br /> For this certification to be complete the operator of the site must include: <br /> • A statement documenting what conecOve actions....Were tilmn or will be taken for each violation <br /> • Copies of sample results/ma ' paperwork,arWor photos ; <br /> verifying corrections <br /> • qpotgtoes certification <br /> Zile <br /> Inspection Inspeded By. — <br /> Fecility'Add ) , EPA! ,;_� <br /> I VIP— <br /> certify.`' under penalty of lair that t/ � 11 <br /> 1. !',have corrected the violations specified in the inspection Re boned I <br /> inspeclkm date. <br /> 2. 'I have personally examined the following n of oompliance FOR <br /> EACH'-A0LA110N and I believe their orm rrto be ,a e, and . <br /> Photos Paperwork Statement <br /> 3. 1 am authorizedto submit this oa ' of the Respondent <br /> i <br /> 4 1 am aw there are sign' pe for false information, includingthe <br /> t possibility of a e and/or im nment r C- ie <br /> ations. (H 5191} <br /> ; � <br /> Mame: l : <br /> Sign Date* <br /> .j <br /> EMD 221 RAI <br />