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OPQUIN' C <br /> ,.'®'�•.'�a SAN JOAQUIN COUNTY <br /> E IRONIVIENTAL HEALTH DEPARTIVIES <br /> W: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> C�•.— �P <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ��IFOR� <br /> OFFICIAL INSPECTION REPORT <br /> FACILITY NAME/TYPE: DATE: - /'' J <br /> 210 17 <br /> ADDRESS: CITY: ` ZIP CODE:_ , <br /> OWNER/OPERATOR: o� TELEPHONE: <br /> TYPE OF INSPECTION: ❑ COMPLAINT ❑ CONSUI TA 1014 1111 OTHEW" PROGRAM RECORD <br /> ELEMENT: 12 <br /> ID#: <br /> NATURE OF COMPLAINT/CONSULTATION: <br /> �- <br /> OBSERVATIONS/COMMENTS: <br /> AN <br /> i <br /> k <br /> �... r <br /> CORRECTIVE ACTIONS: <br /> CORRECT BY: <br /> INSPECTED BY: <br /> RECEIVED BY: DATE: <br /> gym, :t ;re a <br /> EHD 48-05 Inspection Report <br /> 4/9/12 <br />