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SAN .JOAQUIN CO Y <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> W. <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ���/Ad"a�`p• Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd (Q'Z _ 9 gl <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> ame of Facility: C ip Date: —�—I <br /> ddress: City: Zip Code: q <br /> wner/Operator. ch Telephone: <br /> Program Elem nt: ,2 q Program R c rd: 103223 S �'4 • Inspection Type: <br /> BL 80 Posted ❑Yes ❑ permit Posted ❑Y ❑I Re-Inspection on or After: <br /> / ( i <br /> I <br /> 2 _ <br /> 2 t= <br /> - O <br /> 3 � <br /> � o <br /> s <br /> . <br /> - e_ 3 ov 1 lYo <br /> atura -. it <br /> Name: and Sink: .P hlorine: ppm eat: 7-Fxp.Date: arewashing Sink: of uat Amm.: ppm her: f <br /> HEeceived By/Title: <br /> H Specialist: hone: _�za^•� <br /> in: Time Out: SS r IF IV 1 AJ Page of <br /> EHD 1624 (2-pg) 4/3/1 FOOD PROGRAM OIR CONTINUATION <br />