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SAN J0AQUIN Environmental Health Department <br /> —COUNTY— <br /> �_ G,eatness glows here. <br /> Site Location: 03003 N rQhew-a-1 SR# or WP#: <br /> City: Date: _?0 <br /> W No t1(_�Vn t) s V 01 S tP�114 15d ' -)f' <br /> l I <br /> C?JP- <br /> 3 <br /> Q) <br /> Qull ]ZUV) <br /> vL� <br /> N <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />