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STATE OF CALIFORNIA <br />DEPARTMENT OF INDUSTRIAL RELATIONS <br />DIVISION OF OCCUPATIONAL SAFETY AND HEALTH <br />C' '!)SHA <br />, echnology Dr.. Suite 3 <br />Modesto, CA 95356 <br />Telephone: (209)545-7310 <br />EMPLOYER'S SIGNED STATEXIENT OF ABAMIENT OF SERIOUS VIOLATIONS <br />EMPLOI'ER: Jazz Group, Incd Imperial Repair Group, Inc. dba Imperial Truck Wash & Repair <br />ADDRESS: 2142 W. Yosemite <br />Manteca, CA 95337 <br />The law requires that violations observed during the inspection/investigation completed on 02/17/2012 of the place of employment <br />located at 2142 W. Yosemite, Manteca, CA be corrected within the time limit specified. Labor Code 6320(b), requires that you <br />submit this signed 0 <br />. tned statement under penalty of per ' Jury which describes the measures for abating each citation which alleges a serious <br />violation. If the signed statement is not received within 10 working days after the end of the period fixed for abatement, the <br />Division will be required to revoke any adjustments to the civil penalty based upon the assumption that you will abate the <br />violation. This action will result in a doubling of the civil penalty for serious violations. If you have filed a timely appeal with <br />reference to a particular citation, the abatement date is stayed during the appeal process and the Signed Statement need not be <br />subtnitted at this time. In addition, if there are problems beyond your control that prevent meeting a specified abatement date, contact <br />the Division early so that a request for extension can be considered. <br />This signed statement shall be posted for <br />three (3) working days at or near each <br />THIS FORM MUST BE RECEIVED AT TBE ABOVE ADDRESS ON OR place the serious violation referred to in <br />Bt <br />EFORE MAR 0 2 201Z the citaion occurred. <br />Citation <br />Number <br />Number of <br />Instances <br />Measures Taken to Abate Serious Violations <br />Abatement <br />Date <br />All affected employees and their representatives have been informed about abatement activities referenced in this document in <br />conformance with 8CCR Section 340.4(g). Yes I I No <br />I have reviewed the foregoing statement and declare under penalty of perjury that it is true and correct to the best of my knowledge <br />and all submitted abatement information is accurate. <br />Executed at , California by <br />ff-.= <br />Date: <br />Title: <br />OFFICIAL USE ONLY <br />Division Engineer/Industrial Hygienist: Date: <br />District Manager: Date: <br />Close/Comments: <br />Region 2 District 4 Inspection No.21jq259 <br />93 Identification No. -Q2224_ Cal/OSHA Rpt. No. & Fiscal Year 034-12 <br />FEB 2 3 202 <br />