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PUBLIC HEALTH SER110ES <br /> SAN JOAQUIN COUNTY <br /> 'i <br /> NVIRONMENTAL HEALTH DIVISION <br /> Ernest . Fujimoto, M.D., M.P.H., Acting Health Officer <br /> 304 E.Weber Ave., 3rd Floor • P. 0. Boz 388 • Stockton, CA 95201-0388 P <br /> 209/468-3420 <br /> CERTIFICATION OF RETURN TO COMPLIANCE <br /> In the matter of the Violation(s) cited on _ 4 /6& <br /> As Identified in the Inspection Report dated A-21b 7 <br /> Conducted by Pubb �-eY'V CP4 C1 V_ Oe-cA L I V- (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. °Y` �e �r <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 r y examination of the attached documentation and inquiry of the <br /> individualsv�ho prepared or obtained it, I believe that the information is true, <br /> accurate, and complete. <br /> 4. 1 am authori ed to file this certification on behalf of the Respondent. <br /> 5. 1 am aware hat there are significant penalties for submitting false information, <br /> including the possibility of fine and imprisonment for knowing violations. <br /> I( I ►VI " 'I <br /> Name (Print or Type) Title <br /> Signature Date Signed <br /> Company Namd EPA ID. Number <br /> A Division of San Joaquin County Health Care Services <br />