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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:wvvvv-s ov.ol lehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT g--H 1 <br /> Date: <br /> k Name of Facility: r <br /> Address: a-�C� ri city: S �� Zip Code: <br /> Ownerloperator: 1 rA f� ,� Telephone: <br /> Program Element: 1 l0_21 (2-0 t io D Program Record: Inspection Type:B1 880 Posted ❑Yes [IKermit Posted ❑Yes ❑ I Re-Inspection on or After: Spec-41a <br /> i <br /> Ell MI. <br /> ...<... �.:> F <br /> e <br /> I <br /> ..,. bye r v,e. rA-+ (4, <br /> I ncekl <br /> h �, oo <br /> n e CI C <br /> Y 4-i f L� <br /> -err . <br /> ` r r <br /> 3 o Lk-1-i ru 4kn <br /> -rip SA- <br /> Name: and Sink: 'F Chlorine: PPM Heat: 'F <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: ppm Other: of <br /> Received By I Title <br /> EH Specialist: Phone: <br /> ime in: Time Out: Page of <br /> It <br /> � Z� <br /> EK)16-24 (2° pg) 413113 FOOD PROGRAM OR CONTINUATION <br />