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SAN JOAQUIN COUNTY <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web.www.siaov.org/ehd <br /> {rFo� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: S� �� aL_e I Date: 19 r r/7(.0 <br /> Address: z[ dbrie_r qt,City: Zip Code: (Y_ <br /> Owner/Operator: 1A T1", Telephone: �1 � <br /> Program Element: I(Oao Program Record: ca GG 4 f G Inspection Type: CUM CAm+- <br /> 8180 Posted 0 Yes 0 Rermit Posted 0 Yes 01 Re-Inspection on or After: <br /> o stk M E� <br /> -- cc�.l lay n+ r <br /> ma Not See_GLS Vo4e- CA- decd n6Ck )i_(1 in fic�r 1 .1 <br /> C)W�ex�lt n bah+nd S-i vv e . <br /> 'aj- r:Qo M$ <br /> Ord d [M P\2W T0_ <br /> Warewoshloct <br /> Name: Hand Sink: of Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm ther: �F <br /> Received By 1 Title: IVI_ r <br /> EH Specialist: Phone: e)-ock <br /> Time in: Cz LA Time Out: [, -, b 2 1 Page of� <br /> EHD 16-24 (211 pg) 413113 l FOOD PROGRAM OIR CONTINUATION <br />