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SAN JOAQUIN COUNTY-% <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sFgoy.org/ehd <br /> V r;dati' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> ria <iC Date: (' I L- 12— <br /> tltlress: (JSTa WNO City: L Zip Code: �.�L <br /> F e � <br /> Owner/Operator: Lo 1• •e f c],L Telephone: <br /> Program Element: 16 ,yl y Program Record: O w D Inspection Type: <br /> Bt 80 Posted >(Yes No Permit Posted v Yes No Re-Inspection on or After: <br /> ND CORRECTIV. <br /> I T" Cres- car Warw <br /> o / Wara 4 <br /> tklk- -46m ar r kaoa I S or ��✓ <br /> -t +IZIn <br /> u F , <br /> y (3Nrr.}cS <br /> wo\k-i 3C F <br /> Name: k' ,1 end Sink: �. eF hlorine: ppm eat: eF <br /> 1� 11 N <br /> Exp.Date: ,Z _ S arewashing Sink: 1 3d "F uat Amm.: PPMIM <br /> or: 'F <br /> Received By/ <br /> H Specialist: l - , �a� l Phone: r_ <br /> Time In: ` _ 2-D Time Out 12-,',) Page Lot <br /> END 16-24(2-pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />