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"°U'G SKJOAQUIN <br />,o.�... o <br />COUNTY <br />cq;Foa��P Greatness grows here. <br />Environmental Health Department <br />OFFICIAL INSPECTION REPORT <br />FACILITY NAME/TYPE: �t <br />DATE: _42-5) 1-7— <br />ADDRESS: 1 <br />to10 v LJ • (; I71tz ��r �`Ci1 <br />CITY: <br />. <br />ZIP CODE: 6rs- •f4 <br />J <br />OWNER/OPERATOR: <br />i) <br />TELEPHONE #: <br />�i�%�l it <br />TYPE OF INSPECTION: LlCOMPLAINT )4 CONSULTATION ❑ OTHER <br />PROGRAM <br />ELEMENT: <br />RECORD <br />ID#:`> 03 55 Lf O <br />NATURE OF COMPLAINT/ ONSULTATION: <br />roti <br />OBSERVATIONS/COMMENTS: <br />Ib 1 �Z AWAA U <br />2 <br />-rLj <br />CORRECTIVE ACTIONS: <br />- <br />CORRECT BY: <br />INSPECTED BY: <br />RECEIVED BY: .� I <br />DATE: <br />EHD 48-05 Rev. 10/26/2017 Inspection Report <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />