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Note: All, EHD staff time associated with failinglAo, comply by the, above noted date's will be <br />billed atlthi-dUrfek hourly rate of i5 (beginning 8/1/09 thefturly• r <br />ror this certificationto be completethe.. _i of - site must include: <br />• A statement documenting what corrective actions were taken or will be taken for each violation <br />• •• a sample - i ecor,ds/other appropriate paperwork,and/or p • • <br />verifying • • <br />• Operators certification <br />Inspection ate: — S-'— ins ecte :._ Uu <br />Facility Address: Z S- Ay` S . EPA! : 1•• CS <br />.5 <br />i <br />I I have � corrected 1he violations specified in the Inspection Reportftom the above-mentioned <br />inspection date. <br />2. 1 have�oersonally examined the following documentatidn,submifted as proof of compliance FOR <br />EACH VIOLATION and I 6611eveihe information to be true accurate, �ind �6omplete: <br />Photos Paperwork Statement <br />3. 1 amauthorized to submit this certification on behalf of the Respondent. <br />4. 1 am aware that there are significant penalties for submitting false: information, including the <br />possibilityofne and/or'Imptisbriment <br />for i i •:.: • <br />EHD 22-02-005 Rev 06109 <br />Mj' <br />