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U•BLIC�HEALTH SERICES Q�,N <br /> P <br /> SAN JOAQUIN COUNTY H 40' `'°< <br /> ENVIRONMENTAL HEALTH DIV 1ESION., <br /> Ernest M. Fujimoto, M.D., M.P.H., Acting Health Officer <br /> 304 E.Weber Ave.. 3rd Floor • P. O. Box 388 • Stockton, CA 95201-0388 c4., {P <br /> 209/468-3420 `O�~ <br /> CERTIFICATION OF RETURN TO COMPLIANCE <br /> In the matter of the Violation(s) cited on <br /> As Identified in the Inspection Report dated /i:rz3 7 <br /> Conducted by S w.t . (agency or agencies) <br /> v <br /> 1 certify under penalty of law that: <br /> 1. Respondent has corrected the violations specified in the notice of violation cited <br /> above. <br /> 2. I 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 /> Name (Print or Type) Title <br /> Signatufe Date Signed <br /> k L 1d r �.�� oysill � 6 � '2 <br /> 1 (� �C�Q 2A�7 <br /> Company EPA ID. Number <br /> A Division of San Joaquin County Heaith Care Services <br />