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TEL: Jan 26,01 0:00 No .016 P.02 <br />PUBLIC tEALTH SERVICIS <br />SAN JOAQUIN COUNTY ""rd <br />ENVIRONMENTAL HEALTH DIVISION <br />Emelt M. Fujimoto, M.D., M.P.M., Acting Health Officer <br />384 E.Weber Ave., 3rd Floor a F. O. 90x 788 o $socklon, CA 98301-0388 <br />2081468-3420 <br />N21.1111ill• h • ; I. 1 • 0 41 <br />In the matter of the Violations) cited on , 5� <br />As Identified in the Inspection Report dated -?�a�qk <br />conducted by .12o 9e - s ' ��(agency Of agencies) <br />I certify under penalty of law that: <br />1, Respondent has corrected the violations specified in the notice of violation cited <br />above. <br />2, 1 have personalty examined any documentation attached to the certification to <br />establish that the violattons have boon corrected. <br />All <br />3. Based on my examination of the attached documentation and inquiry of the <br />individuals who prepared or obtained it. I believe that the information is true. <br />accurate, and complete. <br />4. 1 am authorized to file this certification on behlaif of the Respondent, <br />5. t am aware that there are significant penalties for submitting false information, <br />including the possibility of fine and imprisonment for knowing violations, <br />—Name (print or Type) Title <br />signature J J f 4. �`�"pat5i9ned <br />C GI�..�'dl-N��, ZNV✓tiTV'lkty i�vt.-CG-J <br />T omo" er UR Jerpuln Co.nq HrrJlh Crit $"VIC" <br />