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SAN JOAQUIN COU, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..• 'L..�;;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.orq/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Q . Bn Date: <br /> Address: �5�y City: C 1 0 C� n Zip Code: 4 <br /> J oe c-t - i G { J T 5 <br /> Owner/Operator: at '\A <br /> \-) Telephone: _G[ f& &—Q <br /> Program Element: Pr gram Record: Q I y I Inspection Type: ,S w V-fl rL4—, <br /> K8-0—posted es ❑ Rermit Posted Yes ❑ 1 Re-Inspection on or After: <br /> new- <br /> b b <br /> OL Y20 ex ✓ V YtGi Y�-e c� - i�u(-� 2 <br /> • I �1C -I-e rs c�[-ems <br /> • :1�(-e e 2e r <br /> o+ Q 6At ce G <br /> O o r <br /> nI ,1-- <br /> ri h <br /> • 8 1 1. L) hQ� <br /> J n Y�_Z_ 4- - 1 _F70_01(_.5 -S h rt_u Ye- <br /> P <br /> r s ✓7 ae <br /> b 13115 <br /> r3 1 jr <br /> 1 <br /> dive r7v-a 4.'11 '10 <br /> G11 f2MQ0 mei <br /> a .. <br /> Name: /'/10 Hand Sink: , � of Chlorine: o 4- W0 ppm Heat: of <br /> rewashin <br /> Exp.Date: _ g Sink: of at.Amm.: 4.-2.0 U ppm Other: of <br /> Received By/Title: <br /> EH Specialist: � -� Phone: <br /> z • c' meg' 0 "7 <br /> Time in: ;!5 Time Out: /D ,t Page of <br /> EHD 16-24 (2na pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />