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�pOA Foy `. SAN JOAQUIN COUA,�! <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> 4�l FO P <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I) <br /> Lou n L Tn h ) Tru Date: -q-�S <br /> ddress: <br /> 17 W. 114--j S� City: 7-r cr < � Zip Code: 9$ � <br /> Owner/Operator: Telephone: 37A; <br /> Program Element: Program Record: Inspection Type: a A n C <br /> SB180 Posted ees No Permit Posted 11Yes No Re-Inspection on or After: <br /> 7..., <br /> BSEA <br /> .e <br /> food hun At Carc/Srir.. aly e,ve re 0/ l2e14 YeC /qs� <br /> -... - — - <br /> -- _ . Wee)Ie .. <br /> --- -----�GJi�___ .-. .Socr G+�_S�1 PnSar R._'�. 6 cf r a du r <br /> hu: r __ — ..�jAr �fn Lin 6-c rrt cl rsi <br /> WA <br /> Name:Q - ,. QNend-CiMc: �20 of hlorine: PPM Het[.„ _IIS °F <br /> Exp.Date: araalaahine Sink: ; of uat.Amm.: PPM ther: =F <br /> Received By/Title: <br /> H Specialist: - Phone: l/ <br /> Time in: '- r/O Time Out: ;Q Page�of,,, <br /> EHD 16-24 (2b pg) 4rS13 Y FOOD PROGRAM OIR CONTINUATION <br />