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,� •�oG SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> 4f R;IFpRt,, <br /> I <br /> I <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f W�1 0+ S Date: -2 <br /> Address: 3 a ) W, lJ ► G n L;rp City' r , Zip Code: G'.Sj C"/ <br /> Owner/Operator: P ; /� � • lTelephone: <br /> Program Element: / J Program/Record: 5 4 O Inspection Type: <br /> t7 r►A <br /> B180 Posted 0 Yes 0 Rermit Posted ❑Yes 01 Re-Inspection on or After: <br /> X <br /> a; <br /> I Ol + a s-tj G a r rt,-c kc cj, <br /> 'l <br /> N frJVt rG Pr n 0 11� -� t+s { ; <br /> EC' I <br /> r0 v: 0112 UI mol) a 6e -J : ; [ q4e ci si <br /> i <br /> jo <br /> P r ryi' 4. onr P o h or Ir boor) <br /> J. <br /> 1S '43-23 <br /> 3-23 i he Ore In r 5 J 71 J. [ G ��/'r u 1 � j <br /> ir <br /> .. ....n.. ' <br /> - <br /> Name: Hand Sink: )O G 'F Chlorine: ppm Heat: "F <br /> Exp.Date: arewashing Sink: ! 'F 4uat.Amm.: ppm Other: 'F <br /> Received By 1 Title: <br /> EH Specialist: - Phone: i/ y. <br /> Time in: Time Out: �/�. t!2 Pagel oto <br /> EHD IS-24 (2"pg) 413113 F00D PROGRAM OIR CONTINUATION <br />