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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 />EHD 23-02-003 Rev 04/02/14 CONTINUATION FORM <br />CONTINUATION FORM <br />OFFICIAL INSPECTION REPORT <br />Page: ; ofd <br />Date: 426X O <br />Facility Address: <br />rg/gyp <br />Program: <br />o� <br />1 <br />� <br />ZOS <br />ti <br />Z <br />y3 <br />Z <br />2 <br />2 <br />O Gut <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 Inspector: <br />Received By: <br />Title: <br />EHD 23-02-003 Rev 04/02/14 CONTINUATION FORM <br />