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SAN JOAQUIN COUk J <br /> gyp..... .. c <br /> ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • C;., „ r ,.�P• Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 11 A-A0 Date: 6-61- 0 <br /> Address: 56-.7- <br /> c� .O/1 � City: b.�..�C,K+On 9152-07 Zip Code: - 5 2-0 <br /> wnerlOperatoor:J Ltri 5 (¢..kri S Telephone: �Ct-_l _r <br /> Program Element: 1(O� Program Record: R 01 QP o8 4 Inspection Type: �/ <br /> B180 Posted l ❑Yes ❑ Rermit Posted ❑Yes ❑i Re-Inspection on or After: <br /> t YYYT-O 1�• 1 <br /> yvt� Y 8 <br /> 1 SIL • 1r C2. <br /> Lf-- Y <br /> n� <br /> . tI WALL-I� eF PL e 0 Y' <br /> — 1 <br /> ea �I � <br /> K9 t' °K <br /> Name: and Sink: 'F hlorine: PPM eat: eP <br /> Exp.Date: arew shing Sink: 'F f <br /> uat.Amm.: PPM er: =P <br /> Received By I Title: <br /> i <br /> H Specialist: / Phone: <br /> ime in: Time Out: _1 ; 7 » Page Lof f <br /> EHD 1624 (2n0 pg) 413113 v�J FOOD PROGRAM OR CONTINUATION <br />