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RETred TO COMPLIANCE CERTIFICATION Any MINOR violations n the`'Notice to Comply" in the attached Inspection Report must be corrected within 30 daysipt of this inspection. This certification form must be submitted to the Environmental Health Dep irtment(EHD) address at the top of this form within 35 days of receipt of the Inspection Report. All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations, re to be submitted using this certification and returned to EHD within 30 days unless otherwise specified n the Inspection Report. Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate ($98). For this certification to be complete the operator of the site must include: • A statement documenting what corrective actions were taken or will be taken for each violation • Copies of sampler sults/manifests/training records/other appropriate paperwork, and/or photos verifying correctioi s • Operator's certification Inspection Date: " lu � oh Inspected By:� eL-l.-e REN?-- Facility Address: W " I � , EPA ID#: 0 0 01%5�.q� I certify under penalty f law that: 2. 1 have personally ex.amined the following documentation submitted as proof of compliance FOR EACH VIOLATIO and I believe the informatioirto-be-true,-accurate,and complete: nfp Photos Paperwork v/ Statement 3. I am authorized to ubmit this certification on behalf of the Respondent. 4. I am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or imprisonment for known violations. (HSC 25191) Name: i 1A F Title: N Y. g �- Si nature: Date: 1 q EHD 22-02-005 Rey 11/07