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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: http://www.sicehd.com/index.html <br /> CONTINUATION FORM Page: of <br /> OFFICIAL INSPECTION REPORT Date: <br /> Facility Address: Sri Program: <br /> t � <br /> K <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 END'S CURRENT HOURLY RATE. <br /> EHD Inspector: Recved By: l Title: a <br /> EHD 23-02-003 Rev 04/02/14 CONTINUATION FORM <br />