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ISAN 3OAQUIN COUNTY UNIFS PROGRAKAGENCY <br />ENVIRdNMENTAL HEALTH DEPARTMENT <br />3Q _-&-WESERAVENUE <br />71 OCkMN <br />, CA 95202 <br />11611M=, 4 <br />In the matter of the Violation cited at: <br />As Identified in the Inspection Report dated on: 4 \e\ gal <br />Conducted by: - Deunis Catanyag [EHD Inspector(s)] <br />I certify under penalty of law that: <br />1. Respondent has corrected the violations specified in the notice of violation <br />cited above. <br />2. 1 have personally examined any documentation attached to the <br />certification to establish that the violations have been corrected. <br />3. Based on my examination of the attached documentation and inquiry of <br />the individuals who prepared or obtained it, I believe that the information <br />is true, accurate, and complete. <br />4. 1 am authorized to file this certification on behalf of the Respondent. <br />S. 1 am aware that there are significant penalties for submitting false <br />information, including the possibility of fine and imprisonment for knowing - <br />violations. <br />Facility Address EPA ID. Number <br />7X—/ &Aj W61c, <br />Name (Print or Type) Title <br />atur Date Sicfned <br />1:-HDCERT (rev 1/07/02) <br />8292 892 GOE T 3NOHd 3nH I G0-1 S, ONO -1 : WON -:1 <br />Ff d WdS0: ET VOW <br />