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,aP" 11@sAG `, SAN JOAQUIN COUNT <br /> *` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> *.,.• Y <br /> Telephone:(209) 468-3420 Fax.(209)464-0138 Web:www.sigov.org/ehd <br /> CIFdA� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: + Date: 'ey <br /> ddress: oo City: Zip Code: <br /> wner/Operator: Telephone: <br /> Program Element: !6 Program Record: /� O Inspection Type: �nR <br /> 8180 Posted es! No Permit Posted C-res ❑No / Re-Inspection on or After: <br /> O Sin <br /> S/ Q <br /> 5� 0 —p as M <br /> 06 sv„ ,rem 4-0-r-e t r ro 4-"f- w - o <br /> ►� s sIC`F kt�alkrn iY <br /> 3a' r bev at'r o°F F <br /> f cuPs TYA <br /> ame: a /' Hand Sink: D of hlorine: ppm eat: of <br /> Exp.Date: // /(01 — l/ 111farewashing Sink: =F Fluall.Amm.: PPM ther: aF <br /> Received By/Title: <br /> EH Specialist: �1 Phone: <br /> ime in://: Time Out: : D Page of <br /> EHD 1624 (2-pg) 4/9/12 FOOD PROGRAM OIR OOWINUA ON <br />