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SAN JOAQUIN COUN,-i <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.orD/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I I S LrT - ,y1 f Date: j 2-/ 7-1 <br /> Address: IIT W. f �n {. oity` TruC zip code: / 37L <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: g c U 4. n <br /> 8180 Posted ❑Yes a No Permit Posted ❑Yes []No Re-Inspection on or After: <br /> t; p. ,'hec q5 r n /CC <br /> eyke h - I u0 -r QI -; � U1 <br /> ame: and Sink: �0 O -F hlorine: PPM eat: .F <br /> Exp.Date: arewashing Sink: / ;G 'F uat.Amm.: PPM ther: "F <br /> Received By/Title: <br /> O <br /> EH Specialist: Phone: �/r.3/ / <br /> b <br /> !me in: Time Out: Page, of <br /> EHD 16-24 (2°pg) 4/8/12 FOOD PROGRAM OIR CONTINUATION <br />