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• A statement documenting what corrective actions were taken or will be taken 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: Inspected <br /> B <br /> 0 Ccu p - <br /> Facility Address: l ��V <br /> EPA ID#:_ <br /> I certify under penalty of law that: <br /> i <br /> f 1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 havee <br /> p rsonally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> Photos—X_—paperwork Statement <br /> I 3. lam authorized to submit this certification on behalf of the Respondent. <br /> i <br /> 4. I am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> 1 <br /> Name: E f] a w( Lk- Title: ' � �c3Y'em o�ry <br /> Signature: <br /> all <br /> November 2004 <br /> a -d TTBE 09t, Boa dgo :al So Sa qej <br />