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SAN JOAQUIN LOCAL. "EALTH DISTRICT E <br /> 1601 East Ha Avenue <br /> Phone 4 181 <br /> STOCKTON, CALIFORNIA le. Stan The Appltul4ton-- <br /> icr GETVERAI: <br /> INSPECTION REPORT � <br /> IF VEHICLE INVOLVED,GIVE <br /> � ES � Make _ <br /> Owner/operator 1 Uaie��-1--- 19 b Lit. No. <br /> t Regist. No. _ <br /> Location— Collor <br /> 1 ( — <br /> mefgeney Telephone No. <br /> 'U'5 Fr m 10LOim Seating Ca <br /> padty <br /> 3 MEAT MARKET <br /> © BAKERY <br /> I 240 k- ❑ ITINERANT RESTAURANT <br /> kJ ❑ FOOD VENDOR <br /> 13 VENDING VEHICLE ► <br /> 4 <br /> 1 <br /> (OCCUPANCY <br /> i <br /> BATHING PLACE <br /> ,ages <br /> NIN <br /> i <br /> y Tele.'No. <br /> i <br /> a { <br /> Received Notice: <br /> JOGI KHANNA, M.D., . H, District Health.Officer <br /> E <br /> rdance with San Joaquin County <br /> E <br /> J I <br /> Regiscered Sanitarian i <br /> EH 00 20 7/85 Date <br /> FOR DEPARTMENT USE ONLY i <br /> Fete Is Du*: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE. ❑ EACH ❑ J�nwry 1 A A�canrrC By J..,y 31 ❑ ,)uty I i Rere6—By Jelly 31 <br /> BASE EXPLANATIONT <br /> BILLtma RE)ATTANCE j RELIT <br /> DATE DATE RFMITTEO AMOUNT OVE CHECKED <br /> fEE / /Li; c' ��t�l <br /> km <br /> AMOUNT <br /> LESS <br /> i <br /> PRORw71pN } <br /> PLUS <br /> PENALTY <br /> OTHER <br /> rr <br /> E <br /> OTHeR - <br /> ri f <br /> RKie.+Q by Date R�.04 No. PW-.I NO. Issuane�OaT� lyiib o <br /> APPIICA►rt—RFn,nn�e C¢PaEYyO ENYtBONY(+fTAL NLALYH 1EIIYiTlSCRYtC><i 1601 f.NAZ[LTON Avg•P.O.Ib,IDt>f� iTOCJCTOK CA OMM �j7� <br />