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PUBLIC HEALTH SERVICES PpUlly <br /> SAN IJOAQUIN COUNTY <br /> z <br /> ENVIRONMENTAL HEALTH DIVISION y <br /> Ernest 1 1Fuji'iri 6to N1.D., M.P.H., Acting Health Officer <br /> 304 E.Weber Ave., 3rd Floor • P. O. Box 388 • Stockton, CA 95201-0388 °q4.'j 6R4, <br /> 209/468-3420 <br /> CERTIFICATION OF RETURN TO COMPLIANCE <br /> tiEGEIVED <br /> In the matter of the Violation(s) cited on /V -9-1911136%SIT <br /> As Identified in the Inspection Report dated 1,�-y-1993 QWFKp �TALH€ALTH <br /> t �ITi //�IP�S <br /> Conducted by LG r/Tid 'S1?i6C S iC bAEL K i i H (agency or agencies) <br /> pug ��� a->J� rh - t�d�t?ctipevrrnt= torr <br /> I certify under penalty of law that- <br /> 1. <br /> hat: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 /> .t) r L TO A/ --? i&-TZ R A& PJ A&A 6-E-PI <br /> Name (Print or Type) Title <br /> L'g&' LL=t— - //-C;\�� 1 1 -13 <br /> s <br /> Signature Date Signed <br /> Lrib i P mL T0C6/ 1A/C_ CAA pp 136 '-19Qy <br /> Company Name EPA ID. Number <br /> A Division of San Joaquin County Health Care Services <br /> 13 , !3 <br />