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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: http://www.s*cehd.com/index.html <br />m <br />EHD 23-02-003 Rev 04/02/14 CONTINUATION FORM <br />CONTINUATION FORM <br />OFFICIAL INSPECTION REPORT <br />Page: / of <br />Date: <br />Facility Address: <br />30 ?6 f p,'y0- <br />Program: <br />1—e /4rZ `!! <br />/ C off/ W / <br />Xe- G <br />4-0 416:�4WK arm 7"al� V <br />c, <br />�/ <br />% G�ti <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD I or: <br />Received By: <br />Title: <br />m <br />EHD 23-02-003 Rev 04/02/14 CONTINUATION FORM <br />