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10/29/1996 14:12 2098585145 BROADBASE PAGE 02 <br /> PUBLIC HEALTH ,SERVICES <br /> SAN JOAQUIN COUN'T'Y <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Ernest M. Fujimoto, M.D.. M.P.H., Acting Health Officer <br /> 304 E.Weber Ave.,3rd Floor • P. 0. Hoz ass i Stockton. CA 95201-0388 <br /> 209/4YrlR-3420 <br /> CERTIFIICAU M OF RETURN TO COMPLIANCE <br /> In the matter of the Vialation(s) cited on q• 30 uo <br /> As Identified in the Inspection Report dated <br /> Conducted by a 41�(C (agency or agencies) <br /> I certify under penalty of law ftiat <br /> 1. Respondent has corrected the violations specified in the notice of violation cited <br /> above. <br /> 2. 1 have personalty 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 Me 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 /> Na (Pri t o e) Title <br /> ff <br /> ignature Date Signed <br /> 1. 0000 l? 0 3 .1— <br /> Company <br /> .1—Company Name U EPA ID. Number <br /> A DION r ed Sim legi CORM"Reaft Cow SWv5M <br />