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PQ N <br /> z c°mss S A N J O A Q U I N Environmental Health Department <br /> --COUNTY CONTINUATION FORM <br /> c'41FoaNj I Greatness grows here. OFFICIAL INSPECTION REPORT <br /> Facility Address: 1.0 Page: _ of <br /> _ <br /> u1Qi1cm COG�a stocrroh Date: 416 2l➢ <br /> a a G Unif hole, tp ffltfJ Id,C - C. 0•S Program: <br /> • wlOw s�ree� b aC ur�i� hole, Yo O(Afisede — C_ 0. 1 GUi�ofaw <br /> "OhIJ01 11 I ►14 q2, 1 S 22 i 222 X22 ar,d 3 Z4� <br /> cup <br /> lei SG 04- awrrL� <br /> 2�(LQ �,381 , 3e4 , 323, 2-1 Le 3 ((e <br /> 115 <br /> VN o -e ro 0 <br /> t� <br /> holt StCUPS 7nd 1v 30 fl DO <br /> ed w()Q.1 lr\-q , ft're <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: Received�y + Title: <br /> A � Ro ro,el CgSle�d y�Z�zs MovS(► Coo��lna o>' <br /> 'qS"t10 na h R <br /> 1868 E. Hazelton Avenue j Stockton,California 95205 T 209 468-3420 1 F 209464-0138 1 www.sjcehd.com <br /> EHD 23-02-003 Rev 10/26/17 CONTINUATION FORM <br />