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002454 0 <br />Any MINOR violations noted in the 'Notice to Comply' in the attached Inspection Report must be. <br />cvrrec_ed within 30 dans of apt of this inspection. This certification fonn must be submitted to the <br />Environhwigal Health Depai#ment (EHD) address at the top of this form within 30 days of receipt of the <br />inspection Rspo <br />All corrections to other -viol ns [toted in the attached InspewOn Repart (IR) or Continuation Form, or <br />disputes to.. Any violations are to be submitted using this certification and returned to EH® v hin 30 ds <br />ung otfterwrise s <br />petered in the Inspection Report. <br />Note: All EHD staff time associated vara failing to comply by the above noised dates will be <br />bulled 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 takeri or viol be taken for each violation <br />• Copies of sample resultslmanifesi raining rewr dsiother appropriate <br />paperwork, and/.or photos <br />verif ,ing corrections <br />® Or'ator's certification <br />Inspection Date: inspected S <br />1 V-7; 1 j 7M r. <br />EPA IDM <br />1. i -have corrected the violations 'spegfied in the Inspection Report from the above-mentioned <br />. Inspectian date. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br />EACH VIOLATION and 1 believe theinformation•to be true,.3 rate, and complete - <br />Photos Paperwork Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />4 l am aware that there are significant penalties for -submitting false information, including the <br />possibilitxof a fine and/or imprisonment for known violations. (HSC 25791) <br />Title: Sf_r, <br />Signature- j ) Date- (o 11-1 <br />900/600'd 8611# 99=Z0 OEOZ/9Z/90 <br />