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PBLICCEALTH SERMCES <br />\.J <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />Ernest M. Fujimoto,. M.D., M.P.H.,. Acting H cer <br />3044-E.WeberAm,. 3rd Floor w P. 0: Box 388" * Stoddmn, OA, 95201 <br />209/468-3420: <br />In- the matter of, the Violation(s) cited on 1 <br />z 1.%iiq �0 . <br />As Identified in the Inspection Reportdated' 2 t1 <br />Conducted by ^)J (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. <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 <br />Name (Print 6r Type) Tits <br />Sign ure ate- Sighed <br />Company Name <br />-. ID. Number <br />A Division of Sew J084WW C001W HeaitR Caen Senica< <br />