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SAN JOAQUIN COUNTY <br /> P <br /> y+ 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 /> �/FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �U �Au n 1 Date: <br /> Is- <br /> Address: 1 4-Q V k�V� n(4 City: yi.�� ��� n Zip Code: <br /> Owner/Operator: poo t i n1 ".1 1 w� Telephone: `4 <br /> t II �Ib V`T <br /> Program Element: i oc Program Record: 7j-7 �/ Inspection Type: rCM I0•'nt <br /> O G <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes [Il 1 Re-Inspection on or After: 1 <br /> NWW TIONS <br /> jPyr - I c CU r ' t h C�� (914t <br /> _ b1 <br /> An 'V4 6-c Cx4 s <br /> G <br /> v.eC Q U)ad �0 IF 4C�S SItbncl Ufi iz> CA �Le,_ - <br /> 4p," r - Ho M vy Ct S1p 5 ti S '16kcec <br /> cfi t cv� n i� -SVM a C <br /> �S17s'r .�U1Ct 1 Y k'`�%M h t rhe i C , ;n t-D <br /> �- a� ��• w �� �� " � r-- 7 �m rc e� <br /> C� Sct U C6D�j 01C�A, Cum �S r <br /> t b (, b �N -1'tleo c V fid o W _ ( f\i n cA\, <br /> Tempera <br /> 777 <br /> Name: and Shik: eF hlorine: ppm eat: of <br /> Exp. Date: rewashing Sink: of Quat.Amm.: ppm ther: of <br /> Received By/Title: - <br /> _ 4 <br /> EH Specialist: ) Phone: <br /> 7 ;{ A- ' It <br /> ime in: r Time Out: i Page of <br /> EHD 16-24(2n'pg) 4IN13 FOOD PROGRAM OIR CONTINUATION <br />