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SAN JOAQUIN COUN--, <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' ov.or lehd <br /> 4�iF6.¢a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: n �' U r nA Date: _ _'(11 <br /> Address: LA2'�5 5 Y City: G1,� Zip Code: <br /> owner/Operator: t v Telephone: 9` -f� +-_ <br /> Program Element: Program Record: n � �,0 Li 6C Inspection Type:IS • <br /> 8180 Posted ❑Yes ❑ Rermit Posted C ❑Yes ❑ I Re-Inspection on or After: <br /> t YlA i� Shu O� tvot �t Y m Ya c�ea�nu-itc�-f <br /> v- v i D lo,4-+c)­ - <br /> Co <br /> . f r <br /> 3Y <br /> .Food Fa i r#fat 1 ...' a areuuai <br /> Name: Hand Sink: °F Chlorine: ppm Heat: 'F <br /> Exp.Date: 1.Z-14—1-7 <br /> arewashing Sink: 'F Quat.Amm.: ppm ther: F <br /> Received By!Title: <br /> EH Specialist: I_ Phone: <br /> Time in: 5 yTime Out: _f _�� Page of ' <br /> EHD 16-24(2° pg) 413!13 FOOD PROGRAM OIR CONTINUATION <br />