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Quip <br /> SAN JOAQUIN COUNTY <br /> 3.• ' �` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s oK.or lehd <br /> eq{i it d'ii�i <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> � Date: <br /> Name of Facility: t f V� 0(A G f <br /> 1 P Q City: Zip Code: <br /> ddress: I li b Ave —T`r a <br /> Telephone: <br /> Owner/Operator: <br /> Inspection Type: <br /> Program Element: Program Record: <br /> ❑Yes ❑ R1 Posted 0 Yes ❑I <br /> B18o Posted e <br /> Re-Inspection an or After: <br /> 1 G fCi / ' 1 P e'raG{ rA IS 79 q ► l� �G1 � <br /> P rr r 01 Or be 1Oc� f. COr p �D 4�a1 <br /> loGr bt ; 1 u —C/t� o�a►/ <br /> c er Y <br /> S Prov: olp Ch16,-i <br /> G IZ c W CT r/I P r -- -+�n }, � W a <br /> _.- <br /> - pro. Kee <br /> � r v r� �✓rr <br /> rntLoaahari 11f't i li Teall nature <br /> i 1 rfP / <br /> oar, <br /> Name: n m S� b N Hand Sink: �GU 'F Chlorine: ppm Heat: °F <br /> Exp.Date: 1 arewashing Sink: r 'F Quat.Amm.: ppm IP <br /> ther: -F <br /> Received By I Title: �(/ 1f r <br /> EH Specialist: Phone: <br /> time in: -, Time Out: Page of <br /> EHD 16-24 (2-pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />