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JUN­26-22003 04 :42 PP1 F. 5 . ... LI_IRE 20'70 3r, 9 r2"1 h. Fir. <br /> V <br /> #3AN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY <br /> ENVIRONMENTAL HEALTH DEPARTMENT$041R WZIBERAVENUE <br /> " <br /> e'Co�K ON.CA 95202 <br /> .,r.,r, rr.rhr�P11f1 [1F RETURN TQ Ct)I�iPL1�1`l� <br /> For H*%ardous.W0'0tW ertgWors .. . <br /> in the matter of the Violation cited on: <br /> As I d <br /> entified.in the Inspeatinn Report dated; <br /> inspector(s)1 <br /> Conduotsd by: <br /> i certify under penalty oflaw that: <br /> d the violations specified In the notice o <br /> Respondent has carracte <br /> violation cited above. <br /> 2. I have personally examined any attached to tthe v oiationts have been coy ation etcted. <br /> certification to establish he <br /> that <br /> examination of the�►+nrhe d c entad and <br /> 3. Based on my or obtained it, I believe that <br /> inquiry of the individuals whoprepared <br /> the information is true, accurate,and comptste. <br /> 4. i am authorized to fife this certification on behalf of the Respond,bnt. <br /> 5, 1 em aware thatthere are significant penalttles f r imprisonment fal is <br /> Information,Including the possibility of fin p <br /> knowing violations. <br /> • Faallity Address EPA 1D: Nurnbar <br /> L. i/fb Titie <br /> Name (Print or Type) <br /> Dat Si ned <br /> Sign <br /> gN�CtftT Iray 9107102) <br />