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Any MINOR violations noted in the"Notice, to Comply , in the attached Inspection Report must be <br />corrected within 3Q days of receipt of this inspection. This certification form must be submitted to the <br />Environmental Health Department (EHD) address at the top of this form within 30 days of receipt of the <br />Inspection Report, HSC 25404.1 <br />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification and returned to EHD within 30 day <br />unless otherwise specified in the Inspection Report, HSC 25185(c)(3) I <br />Note: All EHD 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 completethe operator of the site must include: <br />• 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- Aug ist 8, 2913--.-.- Inspected By:E,Iena Manzo <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentionet, <br />inspection date. <br />2 1 have personally 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 />r, I j- <br />-Photos Paperwork —*/—Statement tv�tM 1/CtCtY\ <br />Name: fZ_' WENY-'Y <br />EHD 22-02-006 Rev 04119112 <br />Title: <br />Date: <br />