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A > Envir *ental Health Department <br /> V� <br /> 0 <br /> RETURN TO COMPLIANCE GERTI Ift-T ►`h�wl�yVCj <br /> b1N3wN®o <br /> Any INOR viol tions noted in the"Notice to Comply"in the attached Inspection Report st be rr ted with 30 d T'N� <br /> receipt of this inspection. This certification form must be submitted to the Environmental alth Depa t ) ddress <br /> at the4op of this form within 30 days of receipt of the Inspeption Report. HSC 25404.1.2(0 <br /> All corrections tc i other violations noted in the attached Inspection Report(IR)or Continuaon ri <br /> violations,are t be submitted using this certification and returned to EHD within 30 days nless otherwise a <br /> Inspection Repo 1. HSC 25185(c)(3) <br /> Note: All EFID staff time associated with fallinO 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 incl de: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifests/training record's/other appropriate paperwork,and/or photos verifying <br /> correcti ns <br /> Opera is certification <br /> Inspection E ate:. October 11, 2018 Inspected By: ZONA BARKER <br /> Facility Addi ess: 2420 W TURNER RD, LORI CERS ID: 10181595 <br /> I certify under penalty of law that: <br /> 1 1 have rrected the violations specked in the Inspection Report from the above-mentioned inspection date. <br /> i <br /> 2 1 have Dersonally examined the following documentation submitted as proof of cc mpliance FOR EACH VIOLATION <br /> and I believe the information to be true,accurate,endco lete: <br /> Photos Paperwork VIE tatement <br /> 3j 1 am authorized to submit this certification on behalf of the Respondent. <br /> 41 1 am ai vare that there are significant penalties for submitting false information, in uding the possibility of a fine <br /> and/orirnpri onment for known violations. (HSG 25191) <br /> dame: Title: 2— <br /> ignatur Date: V 2L' (b <br /> I <br /> i <br /> i <br /> 44 O C U---1+.... A.......1 Q+....W.... f`..lifnrnin OA.Onr.1 7 ')nO ARA_4AOn I ono AAA_n4'1u 1 ........i,.k,4 nnm <br />