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a <br /> San J gayr.i,; . <br /> RETURN TO COMPLIANCE CERTIFICATIC)N <br /> Af'y WNAM vrotatmns noted in the'Notice to comply-in the attached inspectKxn Report must tie <br /> rorc-pt of this inspection This certification form must be sub- <br /> at the top of this form within 30 days of receipt of the in itted� HSC 25404Ma1~� *trTe�+ _ <br /> pection Report tom. <br /> All correc ons to off+ 2(cf(1) _ <br /> b er violations noted in the attached Inspection Report(IR)or Contlnuab4rjn F <br /> vrolatrons, are to be submitted using this certification and returned to EH()within �,,, orm,or <br /> Inspe-cfton Report HSC 2.5185(c)(3) �:�_ unless <br /> Note All EHE) staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> For this certification to be complete, the operator of the site must include-, <br /> A statement documenting ✓✓hat:orrecti✓e actions were taken or will betaken for each violation <br /> Copies of sample rirsultslrnanifF is/training records/other appropriate paperwork, andlor photos venty,r, <br /> corrections <br /> Operator s certification <br /> Inspection Date: October 26. 2015 Inspected By.. Stacy F,1*1;�ra <br /> Facility Address: 550 W Valpic, t-'il CERS IU: 10468777 <br /> I certify under penalty of law that <br /> 1 f have corrected the violations specified in the Inspection Resort from the above-mentioned inspection date. <br /> 2 1 have personally examined the following documentation submitted as proof of compliance FOR EACH V10LAT10N <br /> and 1 believe the information to be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> t 3. t am authorized to submit this certification on behalf of the Respondent. <br /> 4, t am aware that there are significant penalties for submitting false information, including the possibility of afire <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name.— Title ,V � <br /> `'ignaxu . Date 7 <br /> ;� _ f � <br />