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Pq�IN SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMA <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> OFFICIAL INSPECTION REPORT <br /> FACILITY NAME/TYPE: DATE: <br /> , ".1 <br /> ADDRESS: CITY: ZIP CODE: <br /> OWNER/OPERATOR: TELEPHONE#: <br /> Q <br /> TYPE OF INSPECTION: ❑ COMPLAINT ❑ CONSULTATIONOTHER PROGRAM RECORD <br /> ELEMENT: ID#: <br /> NATURE OF COMPLAINT/CONSULTATION: <br /> OBSERVATIONS/COMMENTS: <br /> 1 <br /> ,t' o <br /> CORRECTIVE ACTIONS: <br /> CORRECT BY: <br /> INSPECTED BY: <br /> RECEIVED BY: DATE: _ <br /> EHD 48-05 Inspection Report <br /> 4/9/12 <br />