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SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax.(209)464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: rK Q ry R, <br /> 1 Date: <br /> ddress: : q0S aM 5�aw r Q� City: rJ' Zip Code: <br /> wner/Operator: LOd) >t7 Telephone: <br /> Program Element: �6 3 Z Program Record: I Cy Inspection Type: �� o <br /> B180 Posted 1"es i� No Permit Posted es No Re-Inspection mon or After: <br /> t r�rC IS no rM rLQ- iF'1-1 <br /> ao ��olv�ita�s <br /> izri=C <br /> SCIL V% <br /> o!d :" ( 6 C64'14 I 'Zr+ rgo F <br /> * C (4(cs (= NoC(c+,ka M�'(k 2"F <br /> IAJaIk-,� mob"F <br /> ame: cu SGci�2d _C and Sink: (0Cj of lorine: ppm r <br /> eat: of <br /> Exp.Date: _ _ 16 arewashing Sink: /y ,F uat.Amm.: ppm ther: of <br /> Received By/Title: <br /> H Specialist: Phone: <br /> ime in: /1 ; Time Out: (, SV Page f <br /> EHD 16,24(2-p9) 4IW12 FOOD PROGRAM OR CONTINUATION <br />