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SAN 10AQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />CONTINUATION FORM <br />OFFICIAL INSPECTION REPORT <br />Facility Address: <br />Lim w • sti" e. <br />Page: of <br />Date: <br />Program: <br />CA.4 f a7<7 <br />Ha,zWj CI7 O � Q P/Y1Pw �! dv� ed <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 />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />EHD 23-02-003 Rev 10/26/17 CONTINUATION FORM <br />