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SAN JOAQUIN COUNTY UNIFIEL,,,,.ROGRAM AGENCY J <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E. WEBER AVENUE <br /> STOCKTON, CA 95202 <br /> FEB 1 7 2005 <br /> ENVIRONMENT HEALTH <br /> CERTIFICATION OF RETURN TO COMPLIANCE PERMIT/SERVICES <br /> In the matter of the Violation cited on: ES 4 �1 P(UD n! r# f��afl <br /> As Identified in the Inspection Report dated a-a-mss <br /> Conducted by : [EHD Inspector(s)] <br /> I certify under penalty of law that: <br /> 1. Respondent has corrected the violations specified in the Notice to Comply <br /> and/or Notice of Violation cited above. <br /> 2. I have personally examined any documentation attached to the <br /> certification to establish that the violations have been corrected. <br /> 3. Based on my examination of the attached documentation and inquiry <br /> of the individuals who prepared or obtained it, I believe that the <br /> information is true, accurate, and complete. <br /> 4. I am authorized to file this certification on behalf of the Respondent. <br /> 5. I am aware that there are significant penalties for submitting false <br /> Information, inciuding the pussiuiiliy of fli ie and iimnprisorimiient for knowing <br /> violations. <br /> +-CS ?F1C.1 �I C_ �� lid r.( Q D ��2T IZ: —h <br /> Facility Name Facility Address <br /> Name (Print or Type) Title <br /> I V, Z- %y-0 >� <br /> ignature Date Signed <br /> EHDCERT(rev 11/2/04) <br />