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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:/Iwww.sicehd.com/index.html <br />EHD 23-02-003 Rev 04/02/14 Q— i'.'(-- ",;L— CONTINUATION FORM <br />,CONTINUATION FORM <br />OFFICIAL INSPECTION REPORT <br />Page: of <br />Date: <br />Facility Address: <br />Program: i, <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS II, or MINOR -Notice toMComply) <br />ry <br />cy <br />o <br />t <br />J✓ <br />rl <br />o <br />c t U:5+ 1 14 <br />VLIli, <br />i <br />r <br />Q IJ <br />r <br />t o <br />Q-,w—fV/ � r < P . <br />u. c A Q- <br />A <br />'� A E (e"b wul vt.OWA <br />/t,t- <br />G al I A/--- t fO 5 Q <br />m W <br />41 <br />(U+" <br />O WP-" 0oACkOiyXr <br />LAj°`L,"- <br />5 i 1Aash D h• 31.t? VVU' <br />1,1 <br />'fie <br />ix3 WD 60r t <br />QJL— <br />AK <br />III Ed <br />�:�kwvh <br />1 PcI �l�t CS . <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT <br />THE CURRENT HOURLY RATE. <br />THIS FACILITY IS SUBJECT TO REINSPECTIO AT ANYTIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector: <br />PV6�- AM/V) <br />ReceI <br />Title: <br />P.. 1 <br />EHD 23-02-003 Rev 04/02/14 Q— i'.'(-- ",;L— CONTINUATION FORM <br />