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PUBLIC HEALTH SERVICES <br /> O.P'4llIN, C <br /> ` SAN JOAQUIN COUNTY = Z <br /> ENVIRONMENTAL HEALTH'DIVISION Q <br /> Ernest M. Fujimoto, M.D., M.P.H., Acting Health Officer <br /> 304 E.Weber Ave., 3rd Floor • P. O. Box 388 • Stockton, CA 95201-0388 a<1Fon p <br /> 209/468-3420 <br /> CERTIFICATION OF RETURN TO COMPLIANCE <br /> In the matter of the Violation(s) cited on � y 7 <br /> As Identified in the <br /> Inspection Report datedl�/ ZG f <br /> Conducted byo✓✓I(agency or 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 personally examined any documentation attached to the certification to <br /> establish that the violations have been corrected. <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 behalf of the Respondent. <br /> 5. 1 am aware that there are significant penalties for submitting false information, <br /> including the possibility of fine and imprisonment for knowing violations. <br /> 7 S 7-o,4,«Z I-I kO ID DAC'7-10A/ <br /> Name (Print or Type) Title <br /> 'ZZ) - 7 <br /> Signature Date Signed <br /> A16 yrvzs/V 7cmw �./J/) '�/ 8/ 97102-1e <br /> Company Name EPA ID. Number <br /> A Division of San Joaquin County Health Care services <br />