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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: www.sioov.ora/ehd <br />CONTINUATION FORM <br />OFFICIAL INSPECTION REPORT <br />Page:` of <br />Date: <br />1_'D <br />Facility Address: 1 <br />Progra 0 <br />SUMMARY OF VIOLATIONS <br />CLASS I CLASS II or MINOR -Notice to Comply) <br />fntiv� pa'�n r� �,� - ��g ��,��� <br />150 t t b, C <br />��nS �► Y�r �C, SU roti 11r�,a <br />CWA'vV r 5U �1I <br />404�Q,t1 c(alacrI+ IS Ct��-PShytmk• j(ttt/ <br />Uf7r( -1 W/'/ <br />CCY'IinQ + Tome L vr�a. �h -� coffo f <br />0- m� �1f. <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 A ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector. <br />Receive <br />Title: <br />EHD23-02-003 Rev04119112 /7"'41GO TINUATION FORM <br />