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RETURN TO COMPLIANCE CERTIFICATION <br /> Any N <br /> JLROa violatiorys noted in the`Notice to CQmplY' in the attached In pectfon Refaart must tie orr ted within 3 9 Ufa ,Df <br /> receipt Of this inspection. This caartitication fQrM must be subr'nfttecf to the Environmental Heafth Department(EHE}] ad a s <br /> at the top of this forFn Within 30 days of reCelpt of the Inspectfan Report. HSC 75404.1.2(c)(1) <br /> Ali rorre�;ions S�othar vialatipna noted in the attmched fnspectfon Report SIR)or Continuation corm, or disputes to any <br /> vlofations, are to be submitted using this certificatfon and returned to EHD wi In dans unless otherwise Vecffed in the <br /> Inspecifon Report. HSC 25185(c)(3) <br /> Note: All END staff time associated with failing to cQrnpiy by the above noted dates will he <br /> __,billed Whe-cuaer&h curly-sate <br /> For this certification to be complete, the operator orthosfte mustincfude: <br /> A statement aocufnOnting what rzrrec ve actions were taken or wilt be taken for each Yiolatian <br /> Caples of s2m9le resuftsfmanifestaftraining records/other appfopriate peperwork, and/or photos verifying <br /> oorrectiQns <br /> Opera[or's certification <br /> inspection Date: Avg ust 16, 2919 Inspected By: Lydia Baker <br /> Facility Address: 4304 E FRE MONT ST CERS ID: 10183963 <br /> fCC rtify under penalty of law that: <br /> 1- t have corr6cted the violations specified in the InsPe on Report from the above-menfivned inspection date. <br /> 2. 1 have personally examined the following docuMerl tatian submitted as pravf Of cow 0anCe FOR EACH VIO LATI ON <br /> and I hElieve the information to be true, a"Uraie, and completa; <br /> _Photos_Paperwork—k--statement <br /> 3. f am authorited to subrnit this car 102tica orl behalf of the Respundent- <br /> 3- 1 am aware that there are significant panafres fof 5ubrnitting false information, inctudifl the <br /> _ -- andlor i pris0n;nent-1oF-knor n-known -(HSG 2319 }- _ .-_ 9 possibility of a fine <br /> !Name: A. Title: <br /> Signature& Date: U <br />