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1 <br /> 03/02/2010 10.,28 289e3 6 PAGE 88/88 <br /> ilk <br /> & A� kf <br /> Rmwmw <br /> itumT U; <br /> WO S.MI&'Btu 810013M CA"Z2 <br /> 3" 3 MW mov <br /> ° MAR 1 1 2010 <br /> i UM TO X .W m k. f 6 f xgt(L 'r <br /> IANCE . <br /> Any If&=violstw=voted in dw"Notice W CO[aol 3r is the aftacbed jmspccd=Repw mca tw <br /> tff 11 WiPt of'thi8 bsPoftlm Thus cmdficatton form must be wkenitted to dw <br /> FwnviwwnQDW Hcdhb DVElment MM)addmw at the Imp of We ftm vAthin 35&yj of xmipt of*e <br /> A11 noted in the mUwhed inqnWon Rqmd or condmwtm Fam,nr <br /> ftut=to y vidMom are to be this cafificedon and nmnuW to MD ZWftjUW <br /> 'fled in the hvection Rapart <br /> NoWs AN UM OW*W MOC1004 wft failing to <br /> thA eu t hourly <br /> comply by do be at <br /> raft msj� <br /> For this certffication t0 be C=Pleteof ft site mug° da: <br /> A suftmem docinnantwS wbat cauemve actiow wam bd=o>rwia be U&=for each violatim <br /> • COON Ofis ltt/ g <br /> a8 of P <br /> verifyiamwdons <br /> Xvvwdon Date:---;-4 ti tnopecWd <br /> Fs el_ me w w <br /> I. 1 have cmmased do violstiow od in <br /> 2. 1 have pmwaUy examined the tbll tion sW=imd an Prod of C=PliazwcFOR <br /> EACH VIOLATION and I bdim the informadon,to be late: <br /> --j!::::�PVww6rk ✓s <br /> 3. I am xohorizW to submh tWs cwd&mdm an bdWf of tU Respondmt. <br /> 4. 1 sm a es gubggWhg false Wmradon, <br /> jwNft Me <br /> ty of s fine an&or vioh* .(HSC 2519 1) <br /> sDate: It `� <br /> 9000 vKaDy oawvuaq ZC90 US 596 YU ZC:LO OTOZ/TT/CO <br />