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4ul!± SAN JOAQUIN COUNs .f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-U32 <br /> . T ... P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si-qov.o[g/ehd <br /> �IFOIt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: x2c,00 Date: l- 6 - 15 <br /> Address: �0 1 W, -I I-n� S} City: Trn C Zip Code: 9 S 3 7 L <br /> Owner/Operator: t f Telephone: $3 U. 24 S� <br /> J 1 T�c.' n <br /> Program Element: Ip l q Prog am Record: 5 Ib d/j Inspection <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> C, U 'G S f c,,re[ I(G <br /> :7WRO_ $�#eCBCfifLon '_' ;, o '�. ratue;« r; ashin9 <br /> Name. Hand Sink: of hlorine: PPM Hea -F� <br /> Exp.Date: arewashing Sink: eF lQuat.Amm.: PPM ther: =F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: O Time Out: k Page of <br /> EHD 1624 (2m pg) 413'13 FOOD PROGRAM OIR CONTINUATION <br />