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Pau'" SAN�IUAQUIN P <br /> c Environmental Health Department <br /> 2' 2 <br /> —COUNTY <br /> cep, <br /> gcrFoar' Greatness grows here. <br /> OFFICIAL INSPECTION REPORT <br /> FACILITY NAME/TYPE: DATE: <br /> ADDRESS: // CITY: ZIP COD : <br /> `D g c�, QLIVE LST, S-16CK.TDh) GSZIS <br /> OWNER/OPERATOR: e� TELEPHONE#:oN�Lo y�� <br /> TYPE OF INSPECTION: COMPLAINT ❑ CONSULTATION ❑ OTHER PROGRAM RECORD <br /> ELEMENT: ID#: <br /> NATURE OF COMPLAINT/CONSULTATION: <br /> OBSERVATIONS/COMMENTS: <br /> &sEavED Two Lrx F T <br /> itc+ szGtis <br /> W <br /> CORRECTIVE ACTIONS: <br /> CORRECT BY: <br /> INSPECTED BY: <br /> RECEIVED BY: DATE: <br /> EHD 48-05 Rev.10/26/2017 Inspection Report <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />