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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.siciov.orci/ehd/unitiii.html <br />CONTINUATION FORM <br />OFFICIAL INSPECTION REPORT <br />Page: 5 of 5 <br />Date: 04/11/12 <br />Facility Address: 1019 Bessemer Avenue, Manteca <br />Program: HW <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS II, or MINOR -Notice to Comply) <br />Notes <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, to the EHD within 30 days of <br />receiving this report. <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 />�1 <br />may: <br />Titl, <br />- <br />EHD 23-02-003 Rev 07!12/11 CONTINUATION FORM <br />