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oP4V 1N c <br /> �. �,.F•F .o SAN JOAQUIN COUNTY <br /> 4. ENVIRONMENTAL HEALTH DEPARTMENT <br /> N• :, 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> �/FORS <br /> OFFICIAL INSPECTION REPORT <br /> FACILITY NAME/TYPE: DATE: <br /> ADDRESS: CITY: ZIP CODE: <br /> OWNER/OPERATOR: TELEPHONE#: <br /> TYPE OF INSPECTION: ❑ COMPLAINT ❑ CONSULTATION ❑ OTHER PROGRAM RECORD <br /> ELEMENT: I D#: <br /> NATURE OF COMPLAINT/CONSULTATION: <br /> OBSERVATIONS/COMMENTS: <br /> CORRECTIVE ACTIONS: <br /> CORRECT BY: <br /> INSPECTED BY: <br /> RECEIVED BY: DATE: <br /> EHD 48-05 Inspection Report <br /> 611/09 <br />