Laserfiche WebLink
06/Qt /2008 09:45 2099316743, <br />— 0 <br />WATERLOO SHELL PAGE 01 <br />17, <br />�,gputQC fp A�1V v of anon%., are to = SIADMIT= using Leis C crtujuluvli Y';lt lLlutaxtit: iV t � s.ii yr Rie',iit ty Siuru <br />util.ess otherwise specified in the inspecdon Repurt_ <br />dote: All EHD staff time gssoclated with failing tO comply by the above noted dates Yviil be billed St <br />the eui°rent hourly rate ($9:9)- <br />For M?S calf ca tion it.) be C��1X p'eltZ the operator of the site must include'. <br />A statement documentifixg what correctivc actions were takcn ..or will be taken for cac?::,iolation <br />• conies, of sample results/manifests/training records/uawr approptiate paperwor'ri, and/or photos <br />verifying corrections <br />o Operator's certification_ <br />Inspection Date.--.. 1�� Inspeetedy <br />Facility address: �t5�'��Igl� � �/ �'+ �c7O:_�Q� %G►�'� <br />T certify under penalty of law that: <br />}. I have corrected the violations sPeriiied in the inspection Report from the anove-mentioned <br />inspection date - <br />2, t have personally examined the foilowing documcntatiun subu;itted as proof of compliance FOR <br />EACH VIOLATION and I believe tho inforination to be «ae, acci.a ate, and cor:.ptete_ <br />-,Photos _X_i'ajpc j-:ork Ctztemtert <br />3. i ani authorizeu to submit this cer ificztion on behalf of the Respondent. <br />4_ I am awam titat thele are si�ificant penalties for subt-nitting false information, including the <br />possibilit a fire and/or irr:priscrunent for know.n. viclati=s. (59"519I) <br />r / <br />Name; Title: _. <br />Signature:( <br />Rev i 1/07 <br />� <br />! 11'..1 2 'i I l l l l l l l l i l l If=I ITI I�I�I <br />