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PUBLIC HEALTH SEM110ES <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION y; <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 oq•.. �P <br /> 209/468-3420 <br /> ERTIFICATION OF RETURN TO COMPLIANCE <br /> In the matter of the Violation(s) cited on AnkL- to I kr-'e-'-7 <br /> As Identified in the Inspection Report dated IN?VkL Ib J; -1 <br /> Conducted by S S� `� ��` '�/ (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 perso ally examined any documentation attached to the certification to <br /> establish tha 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 authorizl d 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 /> Nam (Print or Typ I) Title <br /> ob/C)Cl/C'-1 <br /> Signature Date Signed <br /> KEY SCD►.�E ��b IM D'tl�� �-�S'IYLtIX� <br /> 14�D941 SyOC-�G IZ3Ur�PFiR �fzRUlc F �l�L CC�O1 b0 4�4� <br /> Company Name EPA ID. Number <br /> A Division of San Joaquin County Health Care Services ' �� <br />