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cVHy cSAN JOAQUIN COUN) <br /> ) . GG <br /> .a ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.siclov.org/ehd <br /> cr •• R <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C LL Date: __7 — - <br /> ddress: y S City: „I1 Zip Code: <br /> I Owner/Operator: t f` Le 1&XD 1 Teiephone: <br /> Program Element: Z3 ProgramRecord: ,b l —j Inspection Type: <br /> 8180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑ 1 Re-inspection on or After: <br /> 09 <br /> S( 21 ern <br /> 1 4= <br /> .A X11 v <br />. � <br /> E �2i <br /> e CI <br /> ik <br /> 1A 0 <br /> Name: Hand Sink: 1<?�1 -F Chlorine: ppm Heat: "F <br /> Exp.Date: War washing Sink: uat.Amm.: ppm Other: of <br />} Received By 1 Title: y <br />' EH Specialist: L - Phone: <br /> Time in: ,rte Time Out: , Page of ' <br /> e EHD 16-24 (21 pg) 41313 FOOD PROGRAM OR CONTINUATCN <br />