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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson,Pres. City of Lodi <br /> Mary Anna Love,Vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> Patricia E.Vannuccl,Secy. San Joaquin County <br /> Tommy Joyce Stockton, California 95201 City of Escalon <br /> Earl Pimentel <br /> Virginia Mathews (209) 466-6781 Cityof <br /> of Ripon <br /> Daniel L.Flores City of Stockton <br /> John D.Mast,M.D. Jogl Khanna,M.D.,M.P.H.;District Health Officer City of Tracy <br /> San Joaquin County <br /> ADMINISTRATIVE HEARING AGREEMENT <br /> DATE �•�. —ff� <br /> FACILITY ������•t.,tC.. ,��d.�1T_�.�.Y•3 S•- 1�.�.th•� �at 4 �,G•eti <br /> OWNER/OPERATOR <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT REPRESENTATIVES <br /> I► ! &��Q��e.� c. , hereby, agree to have all violations <br /> per inspection report(s) dated — / 7--ef pertaining <br /> to the above referenced establishment corrected on or before <br /> 7—I-7— <br /> I <br /> 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 PROPRIETOR <br /> � C�.f�-c•�t� �M-c. �� ��s7�:r�.+..o tt+-H der s�i� //'/f� ; �'��. <br /> �.✓1 I��1'✓LO! /' + T /` j "fx!f1�/Nf 1'� C f. <br /> ALo <br /> iv cQa-ys <br /> EH 00 42 (Rev 7/88 ) <br /> 3, letoo k- J:C- 7--r_ I — r o /r At <br />