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�_ .r v - •a 1 <br /> `i <br /> SAN JOAQUIN COUH <br /> IF ?+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �•.. ~= .a Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.se6ov.org/ehd <br /> I}. <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i Date: 3 71�, <br /> ddress: City: Zip Code: !3 5 <br /> Owner/Operator: 1 4 Telephoner <br /> Program Element: 1111 Program Record: R I Inspection Type: <br /> 8780 Posted 1-Yes 0 Rermit Posted Yes Q I Re-Inspection on or After: <br /> ......».._...,.... <br /> r i'�,5 19s".?P "Ra1P16iM -'�v..'..•'.�.�:W�w!'}!I Y1 �..' R> . <br /> M <br /> .. o 49 A 4- 1C20 r-S el-t <br /> 0 n 4�12\h AteLiL_ <br /> ` ►-� a �!= c�.oar' etc_ deo r 6-fes . <br /> Y" 6 haVA <br /> �a <br /> i) <br /> I-),o-I-- C_Loa <br /> L� co ` .-, <br /> La. <br /> D Y (&W in(A-P r <br /> F�t A an O)n 0, ro U4 <br /> �C�ra+1�1C <br /> '-4 f- <br /> ._ f1 - '" - - r'_f_ --'---- _ 3_.=- tet ._.__.__ bc� r <br /> (A m-p- rr- ---------- _c''-�_ .. <br /> rs...-;�u rr�.e✓ r 11 �(�' . ��,--W.�� <br /> yW f <br /> •a <br /> )CYMv'67! <br /> e <br /> Name:yfY} err- Hand Sink: f aF Chlorine: pm Heat: _ of <br /> Exp.Date:! r arewashing Sink: ,�QI nF Quat.Amm.: .}ppm Other: of <br /> Received By I It e: <br /> EH Specialist: Phone: 6)��_ C5 <br /> ime in: .Z Time Out: r�! i s,, Page of <br /> FHO 1624 (2n'pg) 413113 FOOD PROGRAM OIR CONTINUATION <br /> �LAaY_ Ll fz- <br />