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SAN JOAQUIN COUNT <br /> = ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> �< P Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.siaov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> EAddress: <br /> Facility: ' <br /> S Date:Q! — <br /> / � rwwS ��e, City: Zip Code: <br /> erator: Telephone: <br /> Element: 7 Program Record: !/ Inspection Typsted 6l Yes No'C Permit Posted v(Yes,n No Re-Inspection on or After: <br /> a w a a! <br /> p-C J .,,_Y"A S In .S..`/vin .e e <br /> 71 t!¢wr <br /> s n wo <br /> 74m�,-n c a <br /> — <br /> Sih k- <br /> Item/Location; / <br /> a` L <br /> 7:*rtczUL 25 ale 1 ,4101-lk- C"` -_/5 <br /> ,cr4 !O' <br /> ir Facility H <br /> Name: Hand Sink: �d 'F F <br /> hlorme: Ppm eat: =F <br /> Exp. Date: , 1oU cs arewashing Sink: Q 'F lQuat.Amm.: PPM ther: of <br /> Received By/Title: <br /> H Specialist: Phone: <br /> Time in: / 2 Time Out: Page of <br /> EHD 16-24 (2n°Pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />