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SAN JOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, California 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: htto://www.sicehd.com/index.html
<br />CONTINUATION FORM
<br />OFFICIAL INSPECTION REPORT
<br />Page: of
<br />Date: 4 Ity fri
<br />Program: Facility Address: i 01./4 2 (4,13, et, WI P-61
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<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: Received By: Title:
<br />EHD 23-02-003 Rev 04/02/14
<br /> CONTINUATION FORM
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