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S A NA OA Q U I N Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> OFFICIAL INSPECTION REPORT <br /> FACILITY NAME/TYPE: c eio I , „ .. �f�(� �' �Q� DATE: ) '2 Z C'I <br /> ADDRESS: 1C�p r D•� "� CITY: C ZIP CODE: <br /> OWNER/OPERATOR: V� TELEPHONE#: <br /> {moi G ,r pa ryL, ��LVI C131 5- <br /> TYPE OF INSPECTION: COMPLAINT ❑ CONSULTATION ❑ OTHERPROGRAM 11 n t RECORD /� D� /,/��� I <br /> ELEMENT: [ ID#: C V 4"` <br /> NATURE OF COMPLAINT/CONSULTATION: <br /> r 4--1 k Y1t LJXY ds aj� <br /> OBSERVATIONS/COMMENTS: <br /> Ri ou- l n G aral,rCt <br /> ,e,,r n'1 C " i <br /> C ow a <br /> rYu o -e. <br /> ro h <br /> qx-d W1 LL E M a,I L m-, Ill-t- H S7 r 5 S <br /> YAct 1w, Ai � W & i r--e- �tlns art <br /> A � <br /> CORRECTIVE ACTIONS: <br /> � vial <br /> CORRECT BY: <br /> INSPECTED BY: <br /> RECEIVED By- DATE: <br /> I /1 <br /> � <br /> EHD 48-05 Rev.10/26/2017 Inspection Report <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />