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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: http://www.sicehd.com/index.html
<br />,CONTINUATION FORM Page: of
<br />IN9PECTION REPORT i3OFFICIA Date: (-, /-.. /20/
<br />Facility Address: /. ' t -to') at' 7 Alk 6 AC tc, Program: 2 qac
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<br />est 64(.3-wrolsciiiv,AcLAss I, CLASS II, or MINOR-Notice to Comply) ' '
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<br />ALL eriD 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.
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<br />Received By: (JA 4 b,k ,f , z;,.„
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<br />Title:
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<br />k .H0 23-02-003 Rev 04/O Y/14 CONTINUATION FORM
<br />Jim
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