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PUB 1(!HEALTH SER ICES <br /> - 'SAN JOAQUIN COUNTY ° .0 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 160 Coto, M.D., M.P.H., Acting Health Officer <br /> 304 E.Webe Ave., 3rd Floor • P. O. Box 388 • Stockton, CA 95201-0388 c9��koa �P <br /> 209/468-3420 <br /> CERTIFICATION OF RETURN TO COMPLIANCE <br /> In the matter of the Violation(s) cited on <br /> As Identified in th Inspection Report dated <br /> Conducted by L -�� ! �" �;c-L �`` (agency or agencies) <br /> I certify under pen Ity of law that: <br /> 1. Responden has corrected the violations specified in the notice of violation cited <br /> above. <br /> 2. 1 have pers nally examined any documentation attached to the certification to <br /> establish th t the violations have been corrected. <br /> 3. Based on y examination of the attached documentation and inquiry of the <br /> individuals ho prepared or obtained it, I believe that the information is true, <br /> accurate, a d complete. <br /> 4. 1 am authori ed to file this certification on behalf of the Respondent. <br /> 5. 1 am aware hat there are significant penalties for submitting false information, <br /> including th possibility of fine and imprisonment for knowing violations. <br /> I <br /> am (Print r Typ ) j Title <br /> f � <br /> Sig -tore Date Signed <br /> r <br /> Company Name EPA ID. Number <br /> A Division of San Joaquin County Health Care Services <br />