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oPA41N. SAN JOAQUIN COUNTY <br /> f ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-62 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www siaov.oro/ehd <br /> ciFba <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Eddress: <br /> : —� l Date: <br /> City: Zip Code: 3Z2Telephone: <br /> : \ n6 – 7t: t S Progra Record: 1Inspection Type: n❑Yes ❑ Kermit Posted ❑Yes ❑1 Re-Inspection on or After: 1 KJ <br /> \ � t <br /> r- I r' <br /> cl <br /> 2 -C1 W` <br /> -m 2 <br /> QA- <br /> 1 1 <br /> -C- 1 <br /> Q W <br /> ame: and Sink: hlorino. ppm eat: •F <br /> xp.Date: ramWjsnip Sink: l of uaL Amm: PPM ther: =F <br /> EHe�elved By I Title: 1♦peciallat: Phone: l�In: Time Out: , Page of <br /> `1 I. 3 <br /> EHD 16-24(2n°pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />