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r <br /> o��ry SAN JOAQUIN COUNTY <br /> yOR�".•�.coG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> e4.• - ` .. Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.si9ov.orwehd <br /> t i iw'o'R <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: <br /> Fame of Facility: l• Cq <br /> S <br /> ess: ! City: Zip Code: <br /> 2SA + It <br /> Telephone: <br /> erloperatar: p$S 1*Pl n , <br /> Program Element: Program Record: inspection Type: COW r74 <br /> 160 G 4 2 <br /> 8180 Posted LiYes ❑ Rermit Posted ❑Yes ❑ C Re-Inspection on or After: <br /> o <br /> S �.�...��.. .. -�.. .. <br /> K o l�1 P o r n <br /> f v D r n <br /> OWAa rW; l Pa �- ► le 4 4 to r e <br /> LA 0n Gn d u bac It h o l,4_ <br /> r W. P.Q e5 01, o CuS /r, aP <br /> ore SerVPa/ L3 C4.4 hroc M5 re ; r4 <br /> Are h idtio <br /> d�P O Cd W; 1how j W asA; r <br /> o I1; }� 0r blowin Ls r)o's a ' na <br /> y <br /> rA8 6i A Co c1 ra a c h <br /> 1. I nod <br /> b wAd,.t _ -o r �nCIIRn Q 6 <br /> N 0. .S Q S 1S iA _f��__C � ♦ OlC; 1i4\ US/ <br /> (y) C) / PSS C Irc1 O 7 V AY rl <br /> 1'4 r 1¢ Y1' i �1ar1 ti )ac� re (4 if#, <br /> 41 <br /> CC,r 1"Pjo , eAl G S n; )1 tor b UC A�p P r <br /> e\of 6 J r 0 A r, 1 P 0 �100 v je O Cc G <br /> Srjai fzer- I QO a 0"Y1 <br /> 1te►��� °° :,� ire <br /> ------- _-- - - ------ <br /> "atr�Il .: rT1liCti :. <br /> :,,• .•. <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: 'F <br /> i <br /> Exp.Date: WarewasXg Sink: `F Quat.Amm.: ppm Other: `F <br /> Received By!Title: <br /> EH Specialist: Phone: / 13 <br /> 3,1_!7 <br /> Time in: ir <br /> / - Time Out: I�j I,. 1 Page of <br /> EHD 16-24 (2nd pg) 4!3113 1 FOOD PROGRAM OIR CONTINUATION <br /> 5 <br /> S <br />