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opauiN. c <br /> SAN .JOAQUIN COUNTY <br /> H ?{ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.orglehd i <br /> gci�aR:+ l <br /> if <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: b•-2,�^) <br /> Name of Facility: 1 <br /> ddress: <br /> 75 _ City: zip Code: ct 5� <br /> 1 1 2. 5 <br /> Owner/Operatbr: !1 f Telephone- ` 2 <br /> IE Of�C�J o <br /> Program Element: ,b2 Program Record: b 3 Inspection Type: 114► . <br /> Jr <br /> B180 Posted IV—yes -1 Rermit Posted ❑Yes EII Re-Inspection on or After: <br /> .t <br /> 2 V. Z <br /> 3 " Q t� <br /> I <br /> ----�1r f, .-�- -C1- _1-�t —_ --- - ' .- ._._. hex- - --------- _--------------_ 0 f=— <br /> Name: �C , Hand Sink: 1�L r 'F11C hiorine: 1�0 ppm Heat: 'F <br /> I Exp.Date: _J arewashing Sink: `Z Z of uat.Amm.: ppm Other: of <br /> i <br /> [EH <br /> eceived By 1 Title: <br /> n <br /> Specialist: Phone: <br /> b C2_ <br /> " ��.rP—� �n 5 \c�cn2.c_ T1 <br />! ime in: 1;; Time Out: 2� L S Page of Z <br /> EHO 16-24(2n°pg)1413113 FOOD PROGRAM OIR CONTINUATION <br />'II EI <br /> 7, j <br />