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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.siaov.org/ehd <br />CONTINUATION FORM <br />OFFICIAL INSPECTION REPORT <br />Page: 5 of 5 <br />Date: 06/28/13 <br />Facility Address: Van de Pol Pacific Pride 351 Beckman Rd. Lodi, CA 95240 <br />Program: HW <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS II, or MINOR -Notice to Comply) <br />Complete and submit a copy of the Return to Compliance Certification form with a statement of how <br />each violation was corrected, including supporting documentation, by July 28, 2013. <br />Ensure that all required information has been entered into the California Electronic Reporting System. <br />This completed report supersedes the original checklist issued to the operator during the inspection. <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: Am <br />Aris Cacapit (209) 468-3453 <br />Received By: <br />o �✓ <br />Title: <br />EHD 23-02-003 Rev 04/19/12 CONTINUATION FORM <br />