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PUBEIC HEALTH SERVICES <br /> SAN IOAQCIN COUNTY = t <br /> JOGI KHANNA M.D.H.P H <br /> Health Officer ., <br /> ,GIFOR�`P <br /> P.O. Box 2009 (1601 East Hazelton Avenue) • Stockton, Califontia 95201 <br /> (209) 468-3400 <br /> C ADMINISTRATIVE HEARING AGREEMENT <br /> DATE <br /> FACILITY <br /> ADDRESS /L0 7 Ai441 5 <br /> OWNER/OPERATOR <br /> San Joaquin County Public Health Services-Environmental Health Division Representatives: <br /> 21 <br /> ,pE�} <br /> I, hereby, agree to have all violations per inspection <br /> report(s) dated x-53 pertaining to the above referenced <br /> facility/premises corrected on or before (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 <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: / y/ <br /> �• J��� � �� h 1S �dtlS/7 �'�/SLS-Z�Cd (.CJ' ���w � U �/J� i1� � <br /> ,�• !"�/Gl/ CPe �.(/yu.^+^+1 l� o Iv G f Ca.n'fI S/G /S ✓�'m!-CZYY <br /> 4(i <br /> Proprietor's Signature <br /> EH 0042.Gen (Rev 7/2/91) <br /> A Division of San jmqum(uunry HMa C; S Mccs C� <br />