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OGRAM AGENCY <br />SAN JOAQO <br />UIN CUNTY UN ' 0 <br />;-��IRGNMENTAL HEALTH *APPMENT <br />3W�.'BER AVENUE <br />STO I CKTOt4- CA 95202 1 <br />W W - <br />• <br />In the matter of the Violation cited on > <br />As Identified in the Inspection Report dated: [EHD Inspector(s)] <br />Conducted by: <br />I certify under penalty of law that: <br />I Respondent has correct . ed the violations specified in the notice of <br />violation cite above. <br />2. 1 have personally examined any documentation attached to the <br />certification to establish that the violations have been corrected. <br />3. BuseJ on my examination of the attached documentation and <br />U.ry of the individuals who prepared or obtained it, I believe that <br />inq . <br />the information is true, accurated comp <br />, anlete. <br />authorized to file this certification on behalf of the Respondent. <br />5. 1 81-n aware that there are significant penalties for submitting false <br />information, including the possibility of fine and imprisonment for <br />knowing violations. <br />Narn I e (Print or Type) <br />EPA ID. Number <br />Title <br />F-HDCERT (rev <br />