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0 aWN cSAN JOAQUIN COUNTY <br /> ,yam ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .., s Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.si4ov.0rg1ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: , Date: <br /> ddress: ky 3 1 City: Zip Code: c1 5 ��+ <br /> Owner/Operator: lam' Telephone: Sqc 0122 <br /> Program Element: Program Record: Inspection Type: <br /> 13180 Posted 17 Yes 0 Hermit Posted 0 Yes []I Re-Inspection on or After: <br /> ........:..::.y,�:pf:�:;::q:ar�.!..y.,>.. <br /> Co `A k Y03 b s Cc w - N s <br /> A t\:._11-:'c-cam- <br /> �. A7 <br /> S <br /> �'. C �, S <br /> �._ <br /> I <br /> te <br /> ytapcoY� f1 � :e Temeratur, <br /> 4 <br /> Name: Hand Sink of Chlorine. ppm Heat: of <br /> Exp.Date: Warewashing Sink: "F 4uat.Amm.: ppm Other: of <br /> Received By 1 Title: <br /> EH Specialist: y Phone: 1-1 <br /> Time in: 1 1 5 Time Out: ,,Z I•� Page of <br /> EHD 16-24 (2111 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />