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rr�-`rh�ars Z.prr� <br /> �o� SAN JOAQUIN CO� �'i noon <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:vvvvw.si- ov.org/ehd <br /> LIFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: +0Y'\ IA o a dV rn L� 10 Date: _av,'S <br /> Address: `a d on `�b t O Vf City: C+0y7 Zip Code: 952,013 <br /> Owner/Operator: sl n Telephone: C "_ Q <br /> Program Element: I (o25 Program Record: P_C) <br /> Ico O Inspection Type: <br /> 6180 Posted Yes ❑ Permit Posted KYes [II Re-Inspection on or After: <br /> Jill <br /> 1.d L'el !0 k-4 moa(Q <br /> I'1 pY o 'FV-e, r-es CS U ris q Y%A'4 r <br /> A 1 ' z.e r-) mo rf— Goa Le r Ot 4cA-4 I c�Le�ol n <br /> w <br /> GI,Q,I n ' ✓► akclY Z ,n b <br /> G I'I.v�►'�d w !-� ► -e �©s-l� ro c�-•r` cl-e�1 <br /> to <br /> n.e-. <br /> Fkv cWa._�, LeA c�Lezlmzd Poe,- aku44-� -z� A 6-e-�o r� <br /> r <br /> n <br /> i.0 a rn. C n <br /> r <br /> od hvin k r eA'rd i /Le-d mcf"4- <br /> W h�i Leh rn,�re_ nF a, aoo r Twt__e_ lLli 1 C�-e�, SOF <br /> al, a'60Y EV-Rr'6�5-� 3° 14, CLOD —13)Lt-C, A," r <br /> 1.+ tAoY /So do .acor C;oo(e ✓ <3LtO <br /> Name: n� e ✓V1 HeRd3inbQn Lt�120F Chlorine: ppm .1 P �s o <br /> Exp.Date: H at: f <br /> I— I _� I (r n Sin eXP ( o f uat.Amm.: 3ODppm ther: 'F <br /> Received By/Title: <br /> EH Specialist: L Phone: <br /> Time in: T Time Out: Page of <br /> 3 <br /> EHD 16-24 (200 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />