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<br /> SAN JOAQUIN COUNTY
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 600 East Main Street, Stockton, California 95202-3029
<br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sogov.org/ehd/unitiii.htmi
<br /> CONTINUATION FORM Page: 3 of 3
<br /> OFFICIAL INSPECTION REPORT Date:
<br /> Facility Address: Program: HW_
<br /> SUMMARY OF VIOLATIONS
<br /> CLASS I,CLASS II,or MINOR-Notice to Com
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<br /> retaining bilis of lading for spent lead ACi1d Uattrrit's for At iFaSi. 3 vear.� on Cite
<br /> NOTES
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<br /> Submit a coov of the "Return to Compliance" certification, along_ with a statement how each violation was
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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($1 15).
<br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT A Y TIME AT EHD'S CURRENT HOURLY RATE.
<br /> EHD Inspect : /`/1 Received By: Title:
<br /> (,�• �V Mezft JeviicAe"C
<br /> EHD 23-02-003 Rev /10 CONTINUATION FORM
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