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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DIST,.iCT SERVING <br /> James Culbertson,Pref. City of Lodi <br /> Mary Anna Love,Vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> Patricia E.Vannuccl,Sec'y. San Joaquin County <br /> Tommy Joyce Stockton, California 95201 City of Escalon <br /> Earl Pimentel City of Manteca <br /> Virginia Mathews (209) 466-6781 City of Ripon <br /> Daniel L.Flores City of Stockton <br /> John D.Mast,M.D. Jogi Khanna,M.D.,M.P.M.,District Health Officer City of Tracy <br /> San Joaquin County <br /> ADMINISTRATIVE HEARING AGREEMENT <br /> DATE <br /> FACILITY t1,1 for- S� a-�-i q►1si Z7Y1C - 3 5 E. A / j r7e <br /> SI oc%fvh <br /> OWNER/OPERATOR ► E, M I k� 0- [� vGL (� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT REPRESENTATIVES QOYIr761 <br /> Senor S0nn ;+a-1—i" Dan Moe 1 , 5 <br /> I, hi kf" rl; , hereby, agree to have all violations <br /> per inspection report(s ) dated —S$? 8—$$. ��,?-$jrf pertaining <br /> to the above referenced establishment corrected on or before <br /> I further agree that said violations may be detrimental to the <br /> public health and/or safety and will prevent these violations from <br /> recurring. Failure to comply with this agreement will result in <br /> further legal remedies . ' ` <br /> „ Ss} <br /> 1� SIGNED BY PROPRIETOR <br />