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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> City of Lodi <br /> James Culbertson,Pres. San Joaquin County <br /> Mary Anna Lore,Vice Pres. 1601 East Hazelton Avenue, P.O. BOX 2009 San Joaquin County <br /> Patricia E.Vannuccl,Sec'y. City of Escalon <br /> Tommy Joyce Stockton, California 95201 City of Manteca <br /> Earl Pimentel (209) 466-6781 City of Ripon <br /> Virginia Mathews City of Stockton <br /> Daniel L Flores City 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 /> ESTABLISHMENT 1 f Y !�JI I /�11j- 1 arfi 175-6 N, W! 15oki 4Vay 15*)ckto h <br /> PROPRIETOR M r / 14 // Ori tt <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT REPRESENTATIVES orl✓Ia n e ra r1 <br /> /-a()rie Co fu iiia Da d1 Moe <br /> I , 'j-0 A ri tfa ! IU Yl r hereby agree* to have all violations <br /> per inspection report( s ) dated /l-a -F '7 pertaining <br /> to the above referenced establishment corrected on or before <br /> /—/�7- moi' <br /> I further agree that said violations are detrimental to the <br /> public health and /or safety and will prevent these violations <br /> from re-occuring at the above referenced establishment. <br /> Failure to comply with this agreement will result in further <br /> legal remedies . <br /> SIGNED BY PROPRIETOR <br />