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i �� I I I AI Environmental Health Department <br /> YSA N U N <br /> r�■z�w� COUNTY <br /> Greorness grows here. <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: STRAW HAT PIZZA, 3228 TRACY BLVD , TRACY 95376 <br /> Change of ownership inspection <br /> OK to permit as a 1626 once annual permit fee is paid. <br /> Pay annual permit fee is$425 online at www.sjgov.org/ehd <br /> Fill out 5021 form provided at inspection. Cross out the previous owner's information (left column)and write in the new owner's <br /> information in the right column. Sign at the bottom and return via e-mail to Kadeanne Linhares (klinhares@sjgov.org).Also <br /> submit a copy of your photo ID. <br /> The person in charge is responsible for ensuring that the above mentioned facility is in compliance with all applicable sections of the California Health and <br /> Safety Code.If a reinspection is required,fees will be assessed at the current hourly rate. <br /> Received by: Name and Title: Went over report with Vikas Sharma, <br /> EH Specialist: KADEANNE LINHARES Phone: (209)468-0330 <br /> FA0003268 SR0082018 SC061 04/27/2020 <br /> EHD 16-23 Rev.06/30/15 Page 2 of 2 Food Program Service Request Inspection Report <br />