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-: - ._ _..... _.... - --._ . .__..__. � sir•. _ <br /> the ►nn of this form. with;-: 20`nvn of rnneint of+hg In-snecti-on per.n.F i-ICrr' 05:104.1 2(cl 1\ <br /> Incrantinn C7-nnrf 1-!Sr ',')G'1Fr(n1!'?%----- <br /> hi11Prl a##Alco rvirrant hrbiirl+i rata <br /> Conus of nmmnlo recnrdsOothnr onnrnnrinte -spec e,ork snalnr nhctos verifri!n G" rnrrnrtinng <br /> Inspection Date: May 06, 2015 Inspected By: MICHELLE HENRY <br /> Facility Address: 16777 HOWLAND RD, LATHROP EPA ID: <br /> 1 CErtify under penalty ul Ic3U4't lci : S4 <br /> i <br /> i. i have corrected the violations specified in the inspection Report rrorn the above-mentioned inspection date. <br /> 2. l have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> I believe the information to be true, accurate, and complete: <br /> —Photos Paperwork Statement I <br /> € <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. am aware that there are sienifcant penalties for submitting false information, including the possibility of a fine andl� <br /> imprisonment for kno%m violations. fHSC:25191) � <br /> Nam�1e. Tltie: <br /> l <br /> € Signature: Date: <br />