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EH- <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> NOTICE TO APPEAR <br /> DATE TIME 1 30pm <br /> NAME(FIRST,MIDDLE,LAST) <br /> RESIDENCE ADDRESS CITY j <br /> BUSINESS ADDRESS CITY <br /> item <br /> DOB SEX HAIR EVES HEIGHT WEIGHT OTHER <br /> INFRACTION MISDEMEANOR SSN: 7 <br /> VIOLATIONS) CODE DESCRIPTION <br /> 6404 . 5(b) CLC- No employer shall ; <br /> knowingly allow smoking in a <br /> workplace. <br /> Q FIRST OFFENSE Q SECOND OFFENSE Q THIRD OFFENSE <br /> LOCATION OFFENSE(S)COMMITTED <br /> Tngide facility at bar located at S <br /> T •T (r .� }'^y QO Qrnnktnn <br /> I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT <br /> EXECUTED AT THE PLACE AND ON ATE SHOWN,ABOVE. <br /> OFFICER: <br /> ?r,t �h- <br /> WRHOUT ADMITTING GUILT,I PROMISE TO APPEAR AT THE TIME AND PUCE CHECKED <br /> BELOW: <br /> xSIGNATURE:Mailed Certified <br /> DATE WITHIN 21 DAYS <br /> 9/12/03 mm 1 : 30 <br /> Stockton judicial C6ffTt, Dept B1 <br /> EYFO,the first MOlafion,a fine of"hundred(f1DD)Callan PN,Slab penol3es. <br /> Q For the second violadon,a fine of n hundred($200)Collar,plus dale Penalties. <br /> Q For Me Mird Noleeon,a One of five hundred(5300)Cohere Plus ebb penenee. <br /> EH 00 38 PHS 161(12/88) <br /> White-COURT COPY Yellow-VIOLATOR'S Copy Pink-ENVIRONMENTAL HEALTH <br /> I <br />