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PUBLIC HEALTH SERVICES a�,N <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <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 <br /> 209/468-3420 <br /> ADMINISTRATIVE HEARING AGREEMENT <br /> DATE I?1 TI9 tS <br /> FACILITY Mmr-r <br /> ADDRESS <br /> OWNER/OPERATOR lestu- Sc o-%+ / umC,(r�ti <br /> San Joaquin County Public Health Services-Environmental Health Division Representatives: <br /> I, U ' e xt�cam,;,,� Vii., hereby, agree to have all violations per inspection <br /> report(s) dated 4 14lbk.N - pertaining to the above referenced <br /> facility/premises corrected on or before C-1�,) zi,, 2 (All reinspections <br /> will be assessed at a rate of$78.00 per hour.) <br /> I further agree that said violations may be detrimental to the public health and/or safety and will <br /> prevent these violations from recurring. I understand that failure to comply with this agreement <br /> will result in further legal remedies and/or may result in the closure of my facility through <br /> suspension or revocation of my Environmental Health Permit. <br /> COMMENTS: �, ! �� L� 'l �' kith .-x- <br /> -T—/ `— 71-725 {)17(l`4-�Ke Z.L-- o! <br /> (20 (Al1I l ��v l ��� I r �I��� � ritt.t- LL �LG r- i-('O --A c L/)n <br /> �,% ; ; ,.���.�j,�)� t� � �7G�>s �f��Ccs �r��z�.�a�.► � � �(�Gu�ak <br /> Proprietor's ISignature <br /> EH 0042.Gen (Rev 8/11/93) <br /> A Division of San Joaquin County Health Care Services <br />