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SAN J O AQ U I N Environmental Health Department <br /> _ COUN I Y <br /> ctr'. Greatness grows here. <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: LODI BOY&GIRLS CLUB,275 POPLAR ST,AGOURA HILLS <br /> Signature not captured due to COVID <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: Roger Coover, Executive Director, <br /> EH Specialist: STEPHANIE RAMIREZ Phone: <br /> SR0083356 SCO61 04/142021 <br /> EHD 16-23 Rev.06130115 Page 2 of 2 Food Program service Request Inspection Report <br />