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PUBLIC, HEALTH SER'!VICES <br /> SAN JOAQUIN COUNTY <br /> JOG[KHANNA M.D,M.P.H. <br /> Health Officer <br /> P.O. Box 2009 0 (1601 East Hazelton Avenue) • Stockton, California 95201 F 6* <br /> (209) 468-3400 <br /> ADMINISTRATIVE HEARING AGREEMENT <br /> DATE <br /> FACILITY /0-4, <br /> ADDRESS (oQ/ , <br /> OWNER/OPERATOR <br /> San Joaquin County Public Health Services-Environmental Health Division Representatives: <br /> .� e,r..r f P9 a ,•,�.;�d �� / �a b� aZ , ��Lf� ca-4--�k' r���-+ �u/�rr� <br /> I, , hereby, agree to have all violations per inspection <br /> report(s) dated /a - —yo ' —��-`�� pertaining to the above referenced <br /> facility/premises corrected on or before _/0 —ra (All reinspections <br /> will be assessed at a rate of $53.00 per hour.) <br /> I further agree that said violations may be detrimental to the public health and/or safety and <br /> will prevent these violations from recurring. I understand that failure to comply with this <br /> agreement will result in further legal remedies and/or may result in the closure of my facility <br /> through suspension or revocation of my Environmental Health Permit. <br /> COMMENTS�Cvrw.z; <br /> a-70— <br /> Proprietor's Signature <br /> EH 0042.Gen (Rev 7/2191) <br /> A Division of San Joaquin County health Care services <br /> P <br />