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QU11y <br /> mac°�2 SQ Nsd OA N Environmental Health Department <br /> a. <br /> COUNTY <br /> cgt1P Greatness grows here. <br /> OFFICIAL INSPECTION REPORT <br /> FACILITY NAME/TYPE: DATE: <br /> ADDRESS: CITY: ZIP CODE: <br /> OWNER/OPERATOR: TELEPHONE#: <br /> TYPE OF INSPECTION: ❑ COMPLAINT ❑ CONSULTATION ❑ OTHER PROGRAM RECORD <br /> ELEMENT: ID#: <br /> NATURE OF COMPLAINT/CONSULTATION: <br /> OBSERVATIONS/COMMENTS: <br /> CORRECTIVE ACTIONS: <br /> CORRECT BY: <br /> INSPECTED BY: <br /> RECEIVED BY: 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 />