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BOARD OF TRUSTEES SelV JOAQUIN LOCAL HEALTH DI•RICT SERVING <br /> James Culbertson,Pres. 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.H.,District Health Officer City of Tracy <br /> San Joaquin County <br /> ADMINISTRATIVE HEARING AGREEMENT <br /> DATE <br /> FACILITY E5-r _/;u I :jTZ)r ,-rnnl <br /> OWNER/OPERATOR <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT REPRESENTATIVES .1AVf-1E l/�n-r ui4- <br /> �SP6Te0 1S/AJQ- 6C t NAJIVA ) IL-gAxJ U16tetAcs TniW � 1797C/A� <br /> Ir , hereby, agree to have all violations <br /> FILE I��ViEW <br /> per dated IBfi 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 /> SIGNED BY PROPRIETOR <br />