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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 <br />EHD 23-02-003 Rev 04/02/14 <br />CONTINUATION FORM <br />OFFICIAL INSPECTION REPORT <br />Page: of <br />Date: t) -,/I <br />Program: <br />Facility Address: 3 <br />u � �S AVE <�(.L I� r� <br />vru ac c-cJ <br />r <br />O C� C(� c -(l r �. <br />, C -IJ <br />moi. It .�✓ <br />VA 111a,01i kt;� <br />v'1 <br />I� <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 />Received BY: <br />Title: <br />CONTINUATION FORM <br />EHD 23-02-003 Rev 04/02/14 <br />