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PUBLIC-HEALTH SERVICES <br /> PiN <br /> SAN JOAQUIN COUNTY '� O°i <br /> r' <br /> ENVIRONMENTAL HEALTH DIVISION : . T <br /> m: < <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 h 30 cq� FOR;:P.. <br /> 209/468-3420 <br /> CERTIFICATION OF RETURN TO COMPLIANCE <br /> In the matter of the Violation(s) cited on 7 - I o - -� <br /> As Identified in the Inspection Report dated 7- 1 o- 9�1 <br /> Conducted by V n WL(-'CIe I (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 /> Daft Y\' . J o ry�\Y) glae7 f DCS 'I C V1Vje 1 <br /> Name (Print or Type) Tit <br /> 0 <br /> �itwrvl �viv��iv1 Z — / 7 — 22 <br /> Signature Date Signed <br /> C�! S —n ," 1 �Tcf l Sl i 0? i;4!3L�L ooc) �� 7-g 3 S <br /> ompany Name J E 10. Number <br /> A Division of San Joaquin County Health Care Services <br />