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MAR 14 '97 ;21PM <br />raz 13 <br />all tA <br />U BL -1w I i I" EON SNER11t,,B <br />SAN JOAQUIN COUNTY <br />HEALTH <br />t <br />M. Fujimoto, •. Acting Hsdlb Ofter <br />30 LWeW Avg., jcd Igeoir S P. Q. Box 388 9 SW404, <br />in the r of - f:. On 1-2-9Z <br />ReportAn ld in the In-spedon dated 1-14-9 <br />_ _ q. <br />u (agency .. <br />P.212 <br />P. big <br />I C@r* undw penalty of law that; <br />2. 1 have penponally examined any documentation attached to the certfication to <br />asWilsh that the Violations _ ••' <br />3. SaW on my 9=nflneaon of the attached dowmentatkm and inquiry of the <br />in&Wvsls who prepared or obtained it, I believe that the inibrmallon is true, <br />amraW and complete. <br />4. 1 am suftrized to lie this ourtffication an behalf of the Respondent <br />5. 1 am aware that there are significant penafts for submitting false information. <br />includIng the possbi* of Me and imprisonment for knowing violalions. <br />He=r. Briloom <br />or ) We <br />3-14-97 <br />$ n Signed <br />_ 40 =4 $Tr <br />EPA ID. Number - <br />A MvbWA W Sae 3GKWv COMM <br />