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i <br /> /SAN JOAQUIN COUNTY UNIFIED PROGRAM�AGENCY � <br /> ENWRONMENTAL HEALTH DEPARTMENT <br /> 304 E. WEBER AVENUE <br /> STOCKTC)N, CA 95202 <br /> CERTIFICATION OF RETURN TO COMPLIANCE <br /> i <br /> R <br /> In the matter of the Violation cited on: 2 J� <br /> As Identified in the Inspection Report dated i Sr <br /> Conducted by : '._1 - Nit ? '/t-c ic_ [EHD Inspector(s)] <br /> I certify under penalty of law that: <br /> 1. Respondent has corrected the violations specified in the Notice to Comply <br /> and/or Notice of Violation cited above. <br /> 2. I have personally examined any documentation attached to the <br /> certification to establish that the violations have been corrected. <br /> 3. Based on my examination of the attached documentation and inquiry <br /> of the individuals who prepared or obtained it, I believe that the <br /> information is true, accurate, and complete. <br /> 4. I am authorized to file this certification on behalf of the Respondent. <br /> 5. I am aware that there are significant penalties for submitting false <br /> information, including the possibility of fine and imprisonment for knowing <br /> violations. <br /> r`!1LLzc1— <br /> Facility Name Facility Address <br /> Name (Print o Type) Title <br /> Sign' ture Date Signed / <br /> HDCERT(rev 11/2/04) <br />