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Sion S <br />�t <br />ty <br />DEPARTMEN' � f ENVIRONMENTAL RESOURCES <br />3800 6��opia way, Suite C, Modesto, CA 95359-9492 <br />Phone: 209.525.6700 9 Fax: 209.525.6774 <br />w .stancounty.com/er <br />FOOD FACILITY INSPECTION OFFICIAL NOTICE <br />Facility: 4- V4 <br />Date: G �_ ' Pg of <br />Address: s- r!� . a, <br />Time In: <br />City: A ^% <4- {y Zip: 3 <br />Specialist: <br />Purpose: ❑ Permit ❑ Routine U Vehicle y <br />rp El ❑ F.B.I. <br />❑ Re -inspection # � p 'Other. <br />r /V <br />COMPLIANCE ___ One re -inspection is conducted at no charge. An escalating service fee is <br />DATE: assessed for each additional re -inspection required. $ - <br />_( will be charged if violations are not corrected by the compliance date. <br />Received by: Date: <br />Updated 8.202020 Original - DER Office / Yellow Copy - Facility <br />.I /r9- •i. <br />f' � �,! /s' ? � .. !-/ �, w..�� <br />"� . <br />75- <br />r <br />/ f { /' <br />/ <br />.. - J ..' / a_ � <br />� .-.. .r-9-, ,f9- <br />Y. .. J • c{ IY(,/�L 3 - - I <br />�. H7 v t <br />/? v" 7 T"`G. <br />!/i _. /� ./ , %.�� <br />/ <br />�!-•.� c• � ^ r .� C {r et .A <br />COMPLIANCE ___ One re -inspection is conducted at no charge. An escalating service fee is <br />DATE: assessed for each additional re -inspection required. $ - <br />_( will be charged if violations are not corrected by the compliance date. <br />Received by: Date: <br />Updated 8.202020 Original - DER Office / Yellow Copy - Facility <br />