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<br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br /> <br />EHD 48-05 Rev. 05/21/18 INSPECTION REPORT <br />Environmental Health Department <br /> <br /> <br /> <br /> <br /> <br /> <br />OFFICIAL INSPECTION REPORT <br /> <br />FACILITY NAME/TYPE: DATE: <br />ADDRESS: CITY: ZIP CODE: <br />OWNER/OPERATOR: TELEPHONE #: <br />TYPE OF INSPECTION:  COMPLAINT  CONSULTATION  OTHER PROGRAM <br />ELEMENT: <br />RECORD <br />ID#: <br />NATURE OF COMPLAINT/CONSULTATION: <br /> <br /> <br /> <br /> <br />OBSERVATIONS/COMMENTS: <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />CORRECTIVE ACTIONS: <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />CORRECT BY: <br />INSPECTED BY: <br />RECEIVED BY: DATE: <br />