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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 Far: (209)468-3433 Web:www.sigov org/ehd <br /> Hazardous Materials Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> COUNTRYSIDE LIQUORS &GAS 1 14971 N HWY 88 , LODI I December 22, 2014 <br /> ALL EHD STAFF TIME ASSUCIAl ED WITH FAILINGTO COMPLY BY THE ABOVE NOIED DATES WILL BE BILLEDAIrTHE CURRENT HOURLY FV717— <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received By(signature): Title: Date: <br /> N <br /> Receive By(printed name): Inspector: Inspector Phone: <br /> NU►{p Me A� f°514 1A 11 I JAMIE DE LA ROSA, HM Specialist II (209) 953-6211 <br /> Page 3 of 3 <br />