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SAN .JOAQUIN COLEY <br /> a: <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sioov.ora/ehd <br /> 4�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _ Date: b_ _t <br /> ddress: �ik _ 1. City: Zip Code: <br /> wner/Operator. �/�� Telephone: <br /> Program Element: 1 q 5 Program Record: S Inspection Type <br /> 8180 Posted 0 Yes 0 Remit Posted Dyes 01 Re-Inspection on or After: <br /> i\ - <br /> U—) Y Et lL <br /> ® w =\ J : <br /> y — - A16-d `cQ -};zD `IS� <br /> S74Q_ <br /> 101= <br /> t <br /> \3 c'—k C'k ' 5 _ <br /> 1-kck , otS <br /> l o o� c a✓� <br /> 15 M 0 <br /> \1 12 d—:c� 1 13- Ill <br /> cl�azsz `h9 2 \ — <br /> u9 <br /> �t2 P <br /> ame: and Sink: "F hlorine: ppm eat: "F <br /> xp.Date: arewashing ink: 'F lo <br /> uat.Amm.: ppmloth <br /> or: "F <br /> Received By/Title: <br /> HSpecialist• Phone: fib. I <br /> ]me in: Time Out: b Pag of <br /> EHD 16-24(2°pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />