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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.sicehd.com/index.html <br />CONTINUATION FORM <br />OFFICIAL INSPECTION REPORT <br />Page: , of 3 <br />Date: <br />Facility Address: Z_ 4/ <br />Program: uyj <br />th <br />Q5 _ <br />_ 01 14 <br />op > <br />x <br />_ s )G <br />Lv' <br />ih Y\yl <br />SL -4-voc <br />Qvj ` r VQQ <br />-In C-1 a S ko VJ <br />a <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 />EH or: <br />Received By: <br />Title: <br />1 <br />EH 23-02-003 Rev 04/02/14 CONTINUATION FORM <br />