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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICTSERVING <br /> City of Lodi <br /> James Culbertson,Pres. San Joaquin County <br /> Mary Anna Love,Vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> Patricia E.Vannuccl,See'y. City of Escalon <br /> Tommy Joyce SIOCkIon, California 95201 City of Manteca <br /> Earl Pimentel (209) 466-6781 City of Ripon <br /> Virginia Mathews City of Stockton <br /> Daniel L FloresCity of Tracy <br /> John D.Mast,M.D. Jogi Khanna,M.D.,M.P.H.,District Health Officer San Joaquin County <br /> ADMINISTRATIVE HEARING AGREEMENT <br /> DATE (�/� <br /> FACILITY <br /> OWNER/OPERATOR <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT REPRESENTATIVES <br /> hereby, �a(gJree to have all violations <br /> per inspec ion report( s) dated S/ �zod 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 PROPRIET R <br /> 3° <br />