Free 53767.pdf - Indiana

Auto Salvage Recyclers Certification Program Return-to-Compliance Plan
State Form 53767 (10-08)

INSTRUCTIONS: 1. BEFORE COMPLETING FORM, make as many copies as needed. 2. Complete a separate Return-to-Compliance form for EACH compliance question that requires one. 3. Attach to the Certification Self-Audit Checklist (State Form 53765) and return entire package to the address in the upper right corner.

Indiana Department of Environmental Management Office of Land Quality/ Industrial Waste Compliance Auto Salvage Recyclers Certification Program 100 North Senate Avenue MC 66-20-2 Shadeland Office Indianapolis IN 46204-2251

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Only submit a Return-to-Compliance Plan for violations that you were unable to correct before certifying. Completing this form does not relieve the facility of its affirmative responsibility to operate in compliance with applicable regulations. Failure to operate in full compliance with the applicable regulations may result in enforcement actions which may include fines or penalties. Facility Name: 1. Please specify the section and question number from The Indiana Department of Environmental Management's publication "Auto Salvage Recyclers Environmental Self Audit Checklist and Workbook" for which you are reporting non-compliance: Section: Question: Describe how you are out of compliance with the requirement referred to above: Page Number:

2. Give a brief description of requirement:

3. What corrective action will you take to return to compliance?

4. Date facility is expected to be in compliance with this requirement (month, day, year):

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