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i �� I I I AI Environmental Health Department <br /> YSA N U N <br /> r�■z�w� COUNTY <br /> Greorness grows here. <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: PIETIES LIQUOR STORE, 202 W ELEVENTH ST , TRACY 95376 <br /> restroom has existing rubber base coving <br /> OK to permit as a 1618 once the annual permit fee is paid ($287) <br /> No signature obtained <br /> Report typed in the office 2:45p-2:59p <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: discussed w/Avtar"Andy"Khinda, ow <br /> EH Specialist: KADEANNE LINHARES Phone: (209)616-3025 <br /> FA0003008 SR0086831 SC061 06/19/2023 <br /> EHD 16-23 Rev.07/05/2022 Page 2 of 2 Food Program Service Request Inspection Report <br />