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SAN JOAQUIN COON, .,i <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> bac/Fey ". Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s1gcv.or /q ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 4 Date: J2. 22, <br /> / <br /> Address: Inq W i I ILA $t City: /nc Zip Code: 95{rb <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: ,A1 i AC <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> ry not A9 81 ;0144 ;4 _ 1r1r Yi..nY..._ <br /> d rc ICrr -- --__-.P1.1As►r�--I r ds - u n cr------� l b ,c---- Sr,�►.v�r ;n W u 1 K <br /> I S g�.__ hr�KI n i C -{c %_ <br /> 3 n a err / ,.5 'L CGMOan�MPn 1 urani n <br /> 9y " in1C-'A in /00_F Or heIirr. Ccrrecko� <br /> C rwssf hrep d IC4 C KS yj T, ) Frn ;M e, 1•iss N <br /> rr ryl(AOrt 1 y be Oinl q bry's A ,W Ihcin <br /> rrle O A'; In l r Glnj 04, Ljo 1W- ;0. <br /> S4ar � � iyyle ;aal <br /> S Clos n cr rrS4 r c.r) fir^ acl-'v . kn "'Ml <br /> C - <br /> 6 Frcn 1 9-6/o," (Aron ) or brc­J-?en GsXe 4_ <br /> W 0,\c perscnl e' s 10 be iA C <br /> Sa ; liL�r• c r n <br /> �i. .-. <br /> *rr 'IAJ ..m K_ afiatr �. vir <br /> -(,�Ocr rPI G <br /> / 4 111-iy� yl F <br /> ame: G _-II.In N4.h4 j. <br /> Hand Sink: V 0O4- 'F h`orine: 20G PPm Cher: <br /> Exp.Date: 1.26 arewasmng Sink: I.Z.G 1 "F Ouat.Amm.: PPM ther: 'F <br /> eceived By/Title: •/(gJ'll' <br /> HSpecialist: Phone: <br /> ime in: Time Out: �f y 3. (� Page ff <br /> END 1624(2b p9) 4013 FOOD PROGRAM OR CONTINUATION <br />