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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.s*qov.org/ehd <br /> tiko"$a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �{ PO CJ?. Date: -,—/I I/ + <br /> Address: 1(L G{n ( y� <br /> City; I �� Zip Code: �a.� <br /> OwnerlOperator: i1�. PGS JAITelephone: 2W_Cj1 <br /> Program Element: t Program Record: 47» 1 f (` Inspection Type: l <br /> VB180 Posted ©Yes ❑ Rermit Posted C f Bees E]I Re-Inspection on or After: f ti 1 <br /> I pct .lel CA"s S_e� (A A_ WOry--VS <br /> ThUZ <br /> ark COePW a IeA-1 1 eS �U CA < PQA-ACJI,-� <br /> �- �F►" - re �� _....--- f . LtS�" -tom F c.� Q <br /> -TKO -- tczR- s `K- -domeoN h 'Chi s site haS <br /> �[�tS f &Jc0a a-- qo <br /> Finda�tEtatt 1dntyibi: r -------- <br /> 'Mrs <br /> Name: f,; U Hand Sink: � -F Chlorine: ` f ppm Heat: 'F <br /> Exp.Date: r� Y� arewashing Sink: f / �� of Quat.Amm.: 1 ppm Other: of <br /> itle: <br /> Received By! ! T 1 l�C <br /> EH Specialist: Phone: <br /> Time in: I a; Time Out: 11 . ' '�- Pagez Z <br /> EHD 1624 (2' pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />