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±, SA JOA I Environmental Health Department <br /> C OOUNTY <br /> RETURN TO OOMPUANCE CERTIFICATION <br /> r yyYBQB VjCbrW&&xrnreri in the"NatIC9 tO Comply"in kN atkaCMd TnspecOxi ReKrt must ba twrecM vAhlrl 30 UYs of <br /> receipt of tftife insp obfa r. 7#ris ci rMcalion farm muss be sub mitW to khe Djviroqrrrerltaf Health DepanweyA(Z-40)address at <br /> the botkom of thi$farm wMYa 30 days of recei A of tFw lnVe�cgor+Roport. HS 25404,4,2(a)(1) <br /> All r orreotigns to.olhef viol-,�tignnQteri in iW at+achoa Ntspe,^EW Repnrt(1R)or GonkinUation Farre,or disputcas to�Lriy <br /> vJctatianv,, are to be submitted mAnq this oef0cation-wd mk irned to[v-HD WAjQ 339 d ry unless okktierwise specrGed in the <br /> Nota: All END staff t#me arss aW with fading to comPlY by the above rioted dates M11 be Wed <br /> at the current hourly rate. <br /> For this c rtifioat(on W be compiete, thi&Or,)OMW 0t'naSite rnrYtlnciude: <br /> A sfakyaW rJm nlin what c4rf$c ve,acllons vmfe Taken or VjI be taken(or eath wWlatlM <br /> Copies a#sarnpfe rel,ordsluther approprfake paperwoik,anNcrpMr- uarilyirMg cu recilons <br /> Qpirator's(:ag( ,af[oA <br /> )nspec#iorr Date: August 2G, 2020 Lnapectted By; MCHOLAS LOEHRER <br /> i <br /> FacHAY Adatross: 804 W GRANT f-�NE RD, (none) CER3 ID: '107820 EI <br /> i <br /> j i comfy urr�arraJry of}av,r th�+l- <br /> t 9. I have+;arree.Wq flye yWaWns V,$Lcified In the Inspeamn Report from ft abovs-niel 4n�d kqspedt vn dole- <br /> 1 have pwson�Ay&xaml red ate kAkw4np dam noimtakion subu ikW as prtsat of c4mpiiEnge FOR r+ JH VtD 7l ON <br /> aTMd Y heli the informaffon to be true, acrerraYa,and uonWlete. <br /> Pflokoser�aor taternenk <br /> t am au ckOzed to zsubmit this czar Vacation cin behalf of die RespoRdeM. <br /> r <br /> 4. !am auras Chat there are sigK1flaant panaltles for submMig fake it tow+ at DTP, irr6ud9ng the pcssiblfiky of a fine <br /> i artWor,kWisorvwn1fnrknown%Aotakiom, (HSC Za491) <br /> f Name; Title: <br /> Sign #;ate; Gate; <br /> i <br /> I <br /> I <br /> r <br />