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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazefton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.siaov.oro/ehd <br />CONTINUATION FORM <br />OFFICIAL INSPECTION REPORT <br />Page: 5 of 5 <br />Date: 05/13/13 <br />Facility Address: George's Mini Mart 18662 N_ Hwy 88 Lockeford, CA 95237 <br />Program: HW <br />SUMMARY OF VIOLATIONS <br />CLASS I CLASS II, or MINOR -Notice to Comply) <br />Complete and submit the return to compliance certification form, corrective action statement for each <br />violation, and any supporting documentation to the EHD by June 13, 2013. <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 />Aris Cacapit (209) 468-345,*V-\ <br />Received By: <br />Title: <br />EHD <br />EHD 23-02-003 Rev 04/19/12 CONTINUATION FORM <br />