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SAN JOAQUIN COU' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138.Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> 4 <br /> Address: o D-ov <br /> tCity: Zip Code: <br /> Owner/Operator: Telephone: M 12) <br /> c�f,a4X 107) <br /> -- <br /> Program Element: Program Record: Inspection Type: <br /> 0)6 7 1. (p <br /> L131 80 Posted 'Nys 13 Kermit Posted S 131 Re-Inspection on or After: <br /> ��P&Sf 6N NU <br /> MIX <br /> A MWeKd <br /> Y'h-W d 5f <br /> A'('AA rrl� ki <br /> 4V <br /> OAMM v4l"� <br /> 54,4 <br /> QOylo nA- <br /> A%KM <br /> AA <br /> 4IM"DA bi�d A14AMA- A&A <br /> CIAAAA-MAAA 11f J A" <br /> z"I Q tA)50M <br /> Mmis jje�� KkC", <br /> 04-"/t4 <br /> 3 <br /> W <br /> M <br /> Name: Hand Sink: 1 of Chlorine: ppm Heat: of <br /> Exp.Date: Z�szhing Sink:: i -Fuat.Amm.: ppm they: of <br /> Received By 1 Title. <br /> EH Specialist: Phone: <br /> Time in: a r Time Out: Page <br /> CHO 16-24 121,1 M) 413113 FOOD PROGRAM OIR C014TINUATION <br />