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From 1.88r -88.1764 Mon May 23 14:55:22 2011 PST vage 2 of 3 <br /> SAN Jou0.Y ' <br /> � . <br /> ETIVIRpNMEIV FAIL HL�ALTkTrDEPAR E 14TtNf <br /> �- 6dQ E.:14Iain Sk;$to�to�ir�t.Q5202=3029 <br /> Trrepba4& 24 }415 -3420Fa (204)A433 Web www.s� ovur /e[�d. <br /> . ►1. i <br /> fiO 'I,IANCERI +T3'IT ` <br /> -.,. <br /> Any MINORiola#ions.:ngted•in the"Notice to Comply"i :the atfaehedspeckipm'Repcnmushe <br /> i <br /> correeted within'30:dans of receipt;of thia•inspecEipi ,:'Flis c ew.Cabo :foM-?�iist: submitted tQ <br /> Env omnen <br /> Health l?epailme�nt.(EHD).add�ss at tho. .�this:for-{ti wi�ti.35 dayv ofi prof <br /> Inspection.Repoit. <br /> All.corrections to other..violations noted iir:the•attached Ins iftn,Report.oi�� t-.n Atib is Fotan,or: <br /> disputeslo:,anyviolations aro°tp:tie su in- �-14C ion,and.Teturnnei :t 'E I within 30,463-,.g . <br /> ,. : ,. <br /> unless.otherwiso sp+e fled l..,the rt; ; <br /> Note.:. All`tE W,;*taff:time associated with:• , -_: '.to com •- tl g*: o gotcd.dates;vM:beWed.At, a <br /> For.this certifta.'tio-I be.vpMpie <br /> tO the o 4 fAq-slo'•must inpl <br /> e ..A stater ent.documeiits`gg yv O correetive actions vige taken:or wi :be; ike Cor:ea.ch.v;ioistto <br /> e. . ' xes.of son► Ye.Tesults/mi i sts/ recaards�other.a ate o or <br /> verifying covedions ; <br /> • Operator° •ceitificatign ... . � :. ::�:; .. <br /> Ins ecti0ll Date: . v?✓' ..'" _ <br /> Facility Address. . .. IV <br /> I vertifyundqr.genattY of l -teat:.. . . <br /> 1. I have corrected the violations:specifiedd in the.Inseetiori:Report.&oni<t ie:g(oveFme'�ifioned;;:.:<: <br /> ihsp�cEcon;date.. '�, • .: <br /> 2. I-bave personally.examined#tE fallowing, c mentation:subinitted as;pi+ribfdfci l aft a �1R <br /> EACH VIOLA-n�ON and I believe the wommtion.to.:l�etxue;accnrat ;:'aad'coniiplote; <br /> Photos. Paperwork S.tatenier�t. ' <br /> =# <br /> 3. lam authorized'to suit this certificatcon:on behalf:of the Respondent: <br /> _ , . .. <br /> 4. I am avrare..:that..there:are:s nilicanf:penaltie, grs l* iti ag-false i n a r ;: i�Oliii pg.tlie• F <br /> pQssli�i'ti of`a.fine arrdfor nment for.ajio kit <br /> tins. �c211' <br /> ty impriso- �. <br /> r <br /> lame: ' . :,.. .::'. <br /> :. <br /> r <br /> .Itle: <br /> 7,7 <br /> Signature: DOO:.... <br /> EHD 22-02-005' .v 10-02 <br />