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SAN JOAQUIN CO' .'Y <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'gov.orq/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L r �f/ Date: <br /> Address: 1 YYL _ / City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: &,)- Program Record: 0S �7 p� Inspection Type: <br /> iSB180 Poste Yes No Permit Posted es No /o Re-Inspection on or After: <br /> 1L Cfivv��i c, 1.acQ <br /> ,w . <br /> �vt C'V w <br /> 'j--PA Y�Lt/wr, u <br /> lit Gt�t� ' <br /> 61, v�� <br /> a <br /> lW 9 an, <br /> a �Ce ,�vvZo <br /> okt <br /> ;Sink: <br /> 1 / �-1 1Name. Hand Sin � Vof Chlorine: Ppm Heat: of <br /> Exp.Date: ( arewasl/0 of Quat.Amm.: ppm Other: of <br /> Received By/Title: I <br /> EH Specialist: V w Phone: _ <br /> Time in: t Time Out: Page f <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />