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aRa 1�• SAN JOAQUIN COUNT- <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> .. ;� Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> °u�at•�` <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -CarQ Date: /C/- // <br /> Address: 0 ;) 1 City: Zip Code: 115'-i115'-i ? 6 <br /> e c <br /> Owner/Operator: Telephone: -d32•.26 q v <br /> Program Element: Program Record: Inspection Type: ROL4 )'.A R <br /> SB180 Posted Yes No Permit Posted Yes No Rednspection on or After: <br /> r �/ I s <br /> GY\ G hGt fe5 � T S ; n S, Grr[c4 <br /> Ne WS P G <br /> ve <br /> /V p hGH S �pr( C1,A10VC" 44 J 'S i <br /> r P -Cr. r <br /> Tru r;d y 77 =— U ► 1 <br /> Name: <br /> Hand Sink: !1 OF hlorine: ppm eat: OF <br /> Exp.Date: '/�, ^ y arewashing Sink: /j of 10Uat.Amm.. ppm r <br /> er: OF <br /> Received By/Title: <br /> H Specialist: 200, <br /> I 62 J� <br /> me In: 0. C) Time Out: <br /> U: J G Page of <br /> EHD 1624 (2b pg) 111M FOOD PROGRAM OIR CONTINUATION <br />