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SAN JOAQUIN COUNTY <br /> ops. ...... e <br /> z ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4 W a`�. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www"s' ov.ol /ehd <br /> LiiWo¢ <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: 7 . <br /> Name of Facility: P <br /> ddress: W �� h City. r a C Zip Code: <br /> So <br /> Telephone: <br /> ownerlOperator: Z <br /> f U fi h <br /> Program Element: 1 b (T C) Program Record: Coo C Ulf" 9 2 inspection Type: <br /> B18O Posted ❑Yes ❑ Rermit Posted D Yes ❑1 Re-Inspection on or After- <br /> ce 6i n - S- /6 <br /> [4f A SP c2k7e' _{761cPP <br /> 0 A IS, /g <br /> dam... G n ►`e _ �..--la- � '�- <br /> IL <br /> G C . WAS I r�rP d F CGH?l� �G i 11 <br /> gc , ifn <br /> 1 tx`lIrrr, f <br /> A <br /> gr 1<P�S 6 art i �� d TGirh3c � G[i -C-42c;► S eJ� <br /> or 0(e. ... c, C " ► r f • ....�se.l/S g b o o � -2 <br /> Z- t o �l rP C e X <br /> T_„ s 4- c O <br /> ! W 1'P r r G larS <br /> r z —..�.._. �1� s _ -4 L b Q r"nr h. �G <br /> A✓ <br /> .oe ii �1 � xpe a Warewashling <br /> Name: Hand Sink: p r �.FChlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: Quat.Amm.: ppm ther: 'F <br /> [EH <br /> eceived By 1 Title: <br /> Specialist: Phone: / fi <br /> ime in: /S _ Time Out: Page of <br /> EHD 16-24{2 P9� 413!13 7 , FOOD PROGRAM CIR CONTINJATiON <br /> S <br />