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bat <br />Fab 04 05 03:36p Ku 0 a 209- <br />1-2750 <br />SAN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E. WEBER AVENUE <br />STOCKTON, CA 95202 <br />Log 41,110 42 0411 1 1, 1 ii 111, zwnf-'Iuel� <br />In the matter of the Violation cited on: 2? --:5 - 6 _ <br />As Identified in the Inspection Report dated <br />Conducted by : '50 14 to S&� eso Al [EHD Inspector(s)] <br />•U re1!!j 111111111111 !!11111 <br />Respondent has corrected the violations specified in the Notice to Comply <br />?nd/or Notice of Violation cited above. <br />3. Based on my examination of the attached documentation and inquiry <br />of the individuals who prepared or obtained it, I believe that the <br />information is true, accurate, and complete. <br />4. 1 am authorized to file this certification on behalf of the Respondent. <br />S. I am aware that there are significant penalties for submitting false <br />information, including the possibility of fine and imprisonment for knowing <br />violations. <br />k1aito7-A -T*r--rbk— /n , E. A"40Y M - <br />At <br />Facility Name Facility Address <br />M4P,1.1 e e!PAfCXN#P.41 -74q -r10A1 <br />Name (Print or Type) Title <br />Signature <br />EHDCERT (rev 11/2/04) <br />p.1 <br />