Laserfiche WebLink
Environmental Health Department <br /> C O k_1 X T . <br /> rur(ra- r; r.. <br /> RETURN TO COMPLIANCE DERTIF)CATION <br /> Any M1UQR violations noted in the'Notice to Comply'irti the atkanhed Inspeebon Report musk be wit 'n da s of <br /> receipt of this inspection- This certification form must ba submitted to the i=nviranmenfaf gait 0e0ar&rren1( )aft&ss at <br /> die hogorn of[iris bm rwilhk 30 days of rec6pl DI The lr)speclton Report, HSG 25404.1,2(c)(1) <br /> All oorracflcrLstog�Fter vlolglon naked in the atfacl ed fnspection €depart{til)or Conlln a Dn Form, nr fes io ani+ <br /> VWJa 9W, ora to be sdbmiIted Lj13i g tb1&certi rKcatian and returned fo l~H D wi ft 3D-.day unless athenvlse specified in the <br /> Inspedtian Repm t. %C 2,51 85(c)(3) <br /> Note. AD EHD staff time associated with failing to comply by the move noted dates wi11 be bill 0d <br /> at the currant hourly rate, <br /> For this certification to be cornpW , the operator oftiie sOo mW hcl ; <br /> R,%tatarrren1 docuner- +rrg what were taken or will bk�,lak$n for each vloi atidtl <br /> C rxpies of sample resultslmanifestsl4ai ning recordsiother approptiate paperwork, andfor Ohotas veriryirtg corrections <br /> Operator's c�eftifluaWn <br /> Inspection date; September 09, 2020 Inspected By: NfGHOLAS LOr7HRER <br /> Facility Address; 24754 fr RNER RO, Escafoa CC-RS ID: 10053733 <br /> I certify under penalty of law that: <br /> 1. l haws corrected Uhs violations specified in the InVaclion Report from the above-meintloned inspection dale. <br /> 2- i have person a�mmi)3ed the following documonta#ion submitted es proof of compilarree FOR EAOO VIOLATION <br /> and i believe the in(orm860n to be true, accurate,and complete: <br /> _Photos,___^_Paperwork nulitement <br /> 3. i am auftorizerl to subrr)jt IWEL ceWficaTian an behalf 4f fhe Respondent, <br /> 4, f am aware that tfrere ares+gnW=t penaWes fnr subrxWng false wnformalion, including the posPiiblliky of a fine <br /> tindlor IrnprisornmerA for known violations- (HSG 25181) <br /> i <br /> 1 <br /> i <br /> I <br /> I <br /> i <br />