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oP4HI" `, SAN JOAQUIN COUt*,_,/ <br /> _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: <br /> e: < <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.org/ehd <br /> A�FOd� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /fes Date: <br /> Address: / A_ City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re Inspection on or After: <br /> ��G,l.�- ��-� C�Evy /X� --Scr»izfl�'� ��i�iCS�rPl9`c✓ - <br /> <7 <br /> - — -- - - ------ - <br /> - <br /> MINER <br /> _ • �ate#y: rtifitA on -T-?� ,�y�. :._. .... -,= ratuie� <br /> 7-F <br /> Name: Hand Sink: -F Marine: PPM eat: <br /> Exp.Date: arewashing Sink: -F Ouat.Amm.: PPM then: -F <br /> Received By/Titl <br /> EH Speci est: Phone: <br /> Time in: Time Out: Page�of <br /> EHD 1624 (2n0 pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />