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o� SAN .JOAQUIN COUNTY <br /> ,oR naso <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ai <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • o.., ;4 Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www,sioov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facilit �e -z `' ,�,;-;�y�. Date: �.-j b <br /> Address: \ City: Zip Code: cl 5:;�3 <br /> Owner/Operator: C V,� Telephone: <br /> Program Element: Zq Program Rec rd: 27� S( Z Inspection Type: <br /> B180 Posted ` ❑Yes C Rermit Posted ❑Yes ❑ I Re-Inspection on or After: <br /> 1 J 51 `OWQ J. ZO <br /> cam- <br /> SC/` i CCS <br /> \ l <br /> C EAAS .z <br /> COS C <br /> ti (Ze �✓ C <br /> Ck <br /> 5 C � c� s•. 3 <br /> Name: and Sink: 'F hlorine: PPM eat: 'F <br /> Exp.Date: arewashing Sink: "F Quat.Amm.: PPM er: 'F <br /> Received By I Title: <br /> EH Specialist: <br /> ime in: 5• `S Time Out: Page of <br /> EHD 1624 (2n0 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />