City of Union City
Environmental
Programs Division
________________________________________________________________________________
34009 Alvarado-Niles Rd., Union City, CA 94587 P: (510)675-5360 F: (510)487-2117
CERTIFICATION OF RETURN TO COMPLIANCE
For Clean Water Program, Hazardous Materials Business Plan,
Hazardous Waste Generator, Tiered Permit (PBR, CA, CE),
Underground Storage Tank, and Aboveground Storage Tank Violations
Facility Name : ___________________________________
Address: _________________________________
In the matter of the violation cited on (date) :
As identified in the Inspection Report dated :
Conducted by (name of inspector) :
Date to send back Cert. of Return to Compliance :
To: Union City Environmental Programs
34009 Alvarado-Niles Rd
Union City, CA 94587
I CERTIFY UNDER PENALTY OF LAW THAT:
1.
2.
3.
4.
5.
Respondent has corrected the violations specified in the notice of violation cited.
I have personally examined any documentation attached to the certification to establish
that the violations have been corrected.
Based on my examination of the attached documentation and inquiry of the individuals
who prepared or obtained it, I believe that the information is true, accurate, and complete.
I am authorized to file this certification on behalf of the Respondent.
I am aware that there are significant penalties for submitting false information including
the possibility of fine and imprisonment for knowing violations.
_____________________________________
Name (Print or Type)
______________________________
Title
_______________________________________
Signature
_______________________________
Date Signed
Attachments Required (listed below):
Office Use Only
Please Submit Items Checked:
Received
Clean Water/Stormwater Program proof of correction
Hazardous Materials Business Plan
Underground Storage Tank documents
Hazardous Waste Generator Waste disposal records
Hazardous Waste Generator proof of EPA ID number
Letter describing each correction made (See back page for format)
Photos (can be sent via email)
K:\FORMS\Certification of Return to Compliance
Not Received
Return to Compliance Letter Requirements
1)
List Violations in the order they appear on the inspection report
2)
Identify each item by the number on the inspection report
Sample Format for Return to Compliance Letter
Hazardous Waste Generator Inspection Checklist
Violation
Number
B.4
D.1
Narrative 1
Correction Made
All waste stored beyond 90 days has been properly disposed of. The Production
Manager is now responsible for tracking hazardous waste accumulation and
disposal using a written log.
All production staff have been provided with a 2 hour hazardous waste training
class covering which products are hazardous wastes, proper handling and
labeling, internal management practices and spill response.
The workstation accumulation area now contains only one drum. In the future
no more than one drum will be present at any time.
K:\FORMS\Certification of Return to Compliance
K:\FORMS\Certification of Return to Compliance