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r <br /> Srav,lq,lQLIN COUNT V <br /> EN%,IR0-,AIE\T.-\I. HE,ILTH DEPARTMENT <br /> 500 Lust blain Street. Stocktoia, CA 95302-3029 <br /> Telephone:1209) 463-3430.Fret:Q09)468-3433 Web �a1vt�.: 'esti cry cltd <br /> RETURN TO COMPLIANCE C TIFICATION <br /> .My AIRN—OI violations noted in the "Notice to Comply" in the attached inspection Report must be <br /> co ectad with'n 30 days of receipt of this inspection. This certification forth must be submitted to the <br /> Environmental Health Department (EHD)address at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All corrections-to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br /> disputes to any violations, are to be submitted using this certitication and returned to EHD within 30 days <br /> witless otherwise specified in the Inspection Report. <br /> Mote: All EHD staff time associated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate ($98). <br /> For this certification t0 be complete the operator of the site trust include: <br /> • A, statement documenting what corrective actions were taken or will betaken for-each violation <br /> • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: /p 03 [aspected By: c <br /> Facility Address:�, ;- _ n 11&U In_� EPA TD#:—_— <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in they Inspection Report from the above-mcxttioned <br /> inspection date. <br /> 2. I have personally examined the Collowing documentation submitted as proot•o(compliance FOR <br /> EACH VIOLATION and I believe the infounation to be true, accurate, ;ind complete: <br /> Photos :�Papetivorkk.Stuteme:nt <br /> 3. I am authorized to submit this Le:rtitication on behalf of the Responde. nt. <br /> 4. I am aware that there etre significant p,:nalties for submitting t;al,su intoniviti,:?tt. i,j,:{ju.(itt(► chc <br /> possibility of a tine and,or imprisonment .liar ktac, &n G iolatio ns. (13.` c J <br /> I ���Zlatltrt . �,1"�. 3 X11 `q..._ . 1.�. @ L ��'('�t • ^+. P`' /t <br />