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CONTINUATION FORM
<br />OFFICIAL INSPECTION REPORT
<br />Page: Y of S----
<br />Date: /-2)2- 10
<br />Program: NO Facility Address: ,,./76 'S. ged4w0.1 0 - Lai CA 'ICYM A040 ShriA X
<br />SUMMARY OF VIOLATIONS
<br />(CLASS I, CLASS II, or MINOR-Notice to Comply)
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<br />ALL END STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE ($115).
<br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE.
<br />EHD Inspector: 4 ,, 1,,,,,e (.....--„ev. Received By:
<br />A:—
<br />Title:
<br />1/,/ niof
<br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT
<br />600 EAST MAIN STREET, STOCKTON, CA 95202
<br />Phone: (209) 468-3420 Fax: (209) 464-0138 Web www.sigov.orgiehd
<br />El-ID 23-02-003
<br />REV 11/25/09
<br /> CONTINUATION FORM
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