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JUN -01-00 THU 04;26 PM P.04t04 <br />05/25!2001B 20: 7 289-1" -1433 <br />uar-crq vtr RM l MCN i Vr i UAIL bb tFIPTH r a� PAGE 07 <br />A7lL'�� 4;JtY 1 KVL <br />C,.RAY [54Vi$ Govamar <br />SAN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY <br />ENVIRONMENTAL HEALTH DIVISION �:... <br />304 E. WERER AVENUE <br />STOCK70N, CA 99202 <br />—SCA I� TOTO Ct]�P3 iANGE <br />Fcr Permft by .Buie, rAMditioaattg MMarfzed, and &mdittouali'p iq�remg Sotffien <br />ID the matter of the Yialation cited on <br />As Identmed in the Iaswtion Report dared <br />coaclu e.d by: <br />I cerdfy ttuder penalty of fare that: <br />1. RESpartdent Inas com-ded the vEoiativus sped in the RGUce of #iaiatxou cited <br />above - <br />1 <br />ha" P=QWWY eta ked 3uT dGumentatlan ztU,*Od t,7 the to AWcatioa to <br />eStabdSll tbtatt tyke viOltiG= hsve been COMCiCd. <br />3. BM04 = my eramisadan. Of the Ittae#ud &CMentallann and inquiry of the <br />individuals who Prepared or obtained it, I bslleve that the iniormatien is #rue, <br />xcemmte, and eanvete. <br />4. I am authorized to f9c, rffls cnrtiicztOA On behalf Of the ReSpOadent <br />5. I am awam that here are sl ant penalties .for sabudtting false Warmatioaz, <br />l9eladbC Me possiMty of flue and imosm=eat for knowing violatians. <br />Name (Print or type) <br />gnait�Qe <br />Title <br />-- . Z — <br />Dam Sigurd <br />c�omF e r 11 �' — <br />BPA MHumoberber <br />0TSC.RE7rC0W.CRr «r <br />