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RETURN TO COMPLIANCE <br />Ll <br />.'6--.RTIFIC4.TION <br />117 7 WT, m77' <br />lim = <br />�n I JU 4 =1 4 t—gim <br />Report QR) or Continuation Form, or <br />For this certification to be complete tfte rator of the site must include: <br />A statement documenting what corrective 'Ya ctions.Wemm taenbr will be taken for each violation <br />Copies of sample resultsiman"s/training iep6rdsiothee appropriate paperwork, andjor photo$ <br />.verifying corrections <br />:1 <br />Iropection Date:_ <br />Faeffity Address <br />I certify under penalty, of law that. <br />1. 1- have Corrected to vkftftn-s specified in the Insr-, <br />inspectiop dqW. <br />2. fhave personally examined the folloyAng documentation' submitted as pod of Compliance FOR <br />EACH VIOLATION and I belleve theIriforma0b to be tim, accurate, and complete.* <br />-Photos =P.aperwork _Statement <br />3. lam authorbmd to submit this certification on beWof the Respondent <br />4 1 am aware t1vt Vwe are significant Penalties 1br � <br />pmibility of a fine ancilor impftonment for known <br />Va-ire: Pwa-- <br />TOO/ TOO'd 86Tt# te96tEE60Z 9Z:OT <br />ZTOZ/TT/90 <br />