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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: httip://www.sicehd.com/index.html <br />CONTINUATION FORM Page- of <br />OFFICIAL INSPECTION REPORT Date:l 17 <br />Facility Address:�jl�Z ���(, Program: <br />E <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 §UBJ§CT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector: 7t-- ! I Received By: I Title. <br />EHD 23-02-003 Rev 04/02/14 CONTINUATION FORM <br />