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"4P1" r SAN JOAQUIN COUP ' <br /> r. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ��YrFsti�:T <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigoy.om/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: a(AllDate: <br /> Address: 5U On 4f' wU city. StDa(-t m Zip Code: GS� <br /> Owner/Operator: U 6T\ SM b1 -In i I V Telephone: b.� 5A Aro <br /> Program Element: 1 1a7 Program Record: Inspection Type: D m .l Re <br /> B180 Posted Yes _ Permit Posted es 0 No Re-Inspection on or Atter: f "- <br /> e i 5 Ovre-cA 1 n SA br,c[d boX s <br /> CA me2�1) CXc co*W n" <br /> Nd Pa ?it 'ftMeAs CA 3- cum sink - f'G1'111 tAA <br /> P� b0 S cl c,fPCam" i IXA- &twdU of Q-&ft Tne oour P- <br /> S Q cAA c4 n Side a bb oMz;�t nmr <br /> soda <br /> IA} A " - jNLX us 1-0 41°F cn he caw VDdb - <br /> rfiov- ucr it cX+ not CM A1C• tUir 10 <br /> S 1 fTQS . <br /> \'46\\\( in cC3l17rY 4 A or- <br /> d Safety Ce . <br /> Name: - and Sink: o 0 ^F hlorine: PPM Heat: -F <br /> Exp.Date: arewashing Sink: ' 2U -F ruat.Amm.: PPM Other: -F <br /> FSpecialist: <br /> itle: <br /> Phone: � , 3 4fc) <br /> Time Out: Page f 2 <br /> . <br /> EHD 1624 (2-Pg) 413V13 FOOD PROGRAM OR GONTINl1ATION <br />