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SAN JOAQUIN CONY <br /> �-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: {209} 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> 'P(IFORtti '" <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / , �� Date: <br /> ddress: `� a h� <br /> ✓}ldw ;4 City: Zip Code: <br /> OwnerlOperator: 4 l l -e, ��G , Telephone: <br /> Program Element:- /„ Q/ L Program Record: Inspection Type: f! <br /> 8180 Posted ❑Yes ❑ Rermit'Posted C)Yes Ll Re-Inspection on or After: <br /> AT1 1 kN I � i nM' 0 r <br /> f <br /> -A,-7 <br /> m a"�- <br /> ^ � x <br /> m....... ..... . . .. m m <br /> :, T Sf ....F i..�. ✓�'. .. ..96{14 `. T.°B,RYft"e">'Glp� <br /> Name: Hand Sink: aF Chlorine: ppm Heat: 'F <br /> Exp.Date: a ng Sink: 'F PP <br /> Quat.Amm.: m Other: 'F <br /> i <br />' Received 8y I Title:" <br /> EH Specialist: Phone: <br /> Time in: Time Out: �] ! Pagel 0 <br /> END 16-24 (2° pg) 413113 FOOD PROGRAM OIR CONTINUATIDN <br />