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SAN .10AQUIN COUNTY <br /> yoP......, co <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> �lF04i <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ✓ Date: /1 <br /> ddress: )AL4� 4,, City: R A— Zip Code: <br /> Owner/Operator: 1 � j v � �L� og Telephone: l — j_il <br /> Program Element: Program Record: -� Inspection Type: <br /> SB18O Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> �`TMMWIRAIWNO" 161T <br /> Apr- <br /> f C � <br /> 1-eA a- Cdu- Gt9 9-- CCs. A— ce i"r <br /> 4 49 <br /> !t f , <br /> LV <br /> I if <br /> �p � � G 't•c� - <br /> LA <br /> L <br /> In `hC�Tl3tti. )7J 1 L <br /> 7777777 <br /> Name: Hand Sink: 'F Chlorine: ppm Hat: 'F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm ther: 'F <br /> Received By/Title: <br /> EH Specialist: Phone fL�y�4l f\ raj 0 3S+2`L <br /> Time in: Time Out: , S� J T Page of <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />