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PUBL; C HEALTH SER . .--ICES <br /> SAN JOAQUIN COUNTY <br /> .�' <br /> NVIRONMENTAL HEALTH 'D'��ISION "!( <br /> Ernest M. Fujimoto, M.D., M.P.H., Acting Health'Ofi;iFer <br /> 304 E.Weber Ave., 3rd Floor • P. O. Box 388 • Stockton, CA 9520Y-41388 <br /> 209/468-3420 F b a <br /> CERTIFICATION OF RETURN TO COMPLIANCE <br /> In the matter of the Violation(s) cited on -/ --3 7 <br /> As Identified in the Inspection Report dated y 3 V 7 <br /> Conducted bye US c &5 ,, (agency or agencies) <br /> I certify under pen lty of law that: <br /> 1. Respondent has corrected the violations specified in the notice of violation cited <br /> above. <br /> 2. 1 have personally examined any documentation attached to the certification to <br /> establish that the violations have been corrected. <br /> 3. Based on rny 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 authorized 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 th' possibility of fine and imprisonment for knowing violations. <br /> E r TH t3 lA n E , 7 D W rU L r2 <br /> Name (Print or Type) Title <br /> Signature Date Signed <br /> u T o C' Ri. ODGl � 9 `�(v (v <br /> Company Name EPA ID. Number <br /> A Division of San Joaquin County Health Care Services <br />