Laserfiche WebLink
W'11.�"-.-, PUBLIC HEALTH SERVT-C.E-S <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />Ernest M. Fujimoto, M.D., M.P.H., Acting Health Officer <br />304 E.Weber Ave., 3rd Floor 9 P. O. Box 388 * Stockton, CA 95201-0388 <br />209/468-3420 <br />05115MI-V=3:4401 <br />In the matter of the Violation(s) cited on -.Z7 JrJ7 <br />As 'Identified in the Inspection Report dated lei -?- 7-f <br />Conducted by JDou S _ &f, A..) We- C1 eLgency 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 />I have personally examined any documentation attached to the %certification to <br />eslabiish that the vioiations 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 />Name (Print or Type) Title <br />Z -14-P.0 <br />Date Signed <br />we!& 15- '-7q 7JQO <br />Company Name EPA ID. Number <br />A Division of San Joaquin County Health Care Services <br />