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" SAN JOAOUIN COUNTe <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> "4e1F6,a� * Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sioov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - - n c _ Date: 2_ �- , 1 <br /> ddress: 11 <br /> It } City: `. / Zip Code: 1753 <br /> 76 <br /> Owner/Operator: Telephone: K35 - - Y S <br /> Program Element: Program Record: Inspection Type: <br /> Runk <br /> 58180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> 7cof <br /> LQ II �G i11�s uL reS fr'A ne PS 1ra ;n � O S <br /> ry ✓; pQ b c4 rr:er ? <br /> I <br /> n d cod e. 4e an d. ; n C I neS <br /> I rN 'L ee K . <br /> vac DO t� re <br /> F <br /> ame: ;N/A7- and Sink: 1(70�I 'F hlorine: Ppm eat: "F <br /> Exp. <br /> Narewashing Sink: .gyp `FMet Arnim.: PPM Other: 'F <br /> Received By/Title: <br /> EH Specialist: 017Ph e: <br /> me In: 16 <br /> Time Out: b- 7 2 Page of_ <br /> EHD 16-24 (2-pg) 11/2109 J FOOD PROGRAM OIR CONTINUATION <br />