Laserfiche WebLink
SALT <br />PUBLIC H SERACES <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 • P. O. Box 388 9 Stockton, CA 95201-0388 <br />209/468-3420 <br />CERTIFICATION OF RETURN TO COMPLIANCE <br />In the matter of the Violation(s) cited on <br />//. 67, gg <br />As Identified in the Inspection Report dated //°'� ' i s <br />Conducted by '9' -Ac 0164'6e �� �ar'E�G�n.�Y �p'�'c�5 (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 />PE -FI -P, '144 1:-At-L- <br />Name (Print or Type) <br />0 <br />Signature <br />FL"4NT I- NJAC-)F-12 <br />Title <br />(. Z k.' $ <br />Date Signed <br />(-i3 12.e-�"-%Jd-e. I . CAL ocOtV,3 69.3 <br />Company Name EPA ID. Number <br />A Division of San Joaquin County Health Care Services <br />