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SAN:IOAQUIN Environmental Health Department <br /> -COUNTY-- <br /> Site Location: (D SR# or WP#: <br /> City: Date: <br /> t <br /> SI414 , <br /> O� <br /> o � <br /> N� <br /> t - <br /> I <br /> I <br /> 9� <br /> L <br /> 100 � Il <br /> � <br /> V) a e,ry) e— A�j P_ — A� <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />