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aaRA 1ry,.,A ✓ SAN JOAQUIN COUN' -.., <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> *`/fdaNp Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: k Date: <br /> Address: 0 .l F City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: ` S. Program Record: /(v -19, Inspection Type: <br /> B180 Posted 7 Yes - No Permit Posted es I.! No Re-inspection on or After: <br /> p 3 <br /> LZ!? -C.0 / LOrILC 4 <br /> S 17 L / T 7C/ <br /> l c : 6Lsi ✓9-ee— <br /> '>Z <br /> �.- <br /> �a� <br /> we I k4-A coo,bar JS•F <br /> Name: and Sink: 103 `F hlorins: ppm eat: .F <br /> Exp.Date: arewashing Sink: 'F ruat.Amm.: ppm that: 'F <br /> Received By/Title: U19100 <br /> _ <br /> EH Specialist: Phone: <br /> ime in: Time Out: Page ofW/6 agn <br /> Z <br /> EHD 1624 (2w pg)4/9/12 FOOD PROGRAM OIR CONTINUATION <br />