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Raufn., SAN JOAQUIN COUP Y <br /> Q �.. <br /> ENVIRONMENTAL HEALTH DffGARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 'ci F d'n"• <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: T 12q/1 D <br /> Fdd <br /> : h �\. City Zip Code: q�j20 <br /> S�OC/� �W . Telephone: o <br /> : SV incW- S\O _ ,Pro ramR ord: Inspection Type:nt: I �� g G 000 3b�' i b Yes 0 No Permit Posted I-Yes 0 No <br /> Re-Inspection on or After: <br /> Uammw <br /> a20j t Ck \\Ute 0V i\\E I IL � r.2d1 w 7lat, <br /> - c 1ec rut�c�r Gb'eS oh a►1 aNc�s <br /> of Trw- . -m.e xX iaitton <br /> - The n'011- i nb. C s 1 l U Th <br /> i f\�etr }t\1 if nsU milk ; bath 1m2 <br /> Nain�-as� �i\k s�rviclz. ah C,I�2G� � 1rU �cn` �eS <br /> Name: Hand Sink: of hlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: -F uat.Amm.: PPM ther: 'F <br /> Received By/T' le: r. <br /> EH Specialist: _ Phone: ,I) 1 r <br /> Time in: Time Out: (i-'-' o Page;of i <br /> EHD 1624 (2ntl Pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />