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� SAN JOAQUIN COUNI.� <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �;........ ° Telephone: (209) 468-3420 Fax.(209)464-0138 Web:www.sigov.org/ehd <br /> 4�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: co * O Date: <br /> Address: r 7 q /_l:f col /7 �..n City: —Tr- , (I Zip Code: <br /> Owner/Operator:) t I Telephone: <br /> Program Element: Program Record: Inspection Type: d jh f <br /> 8180 PostedEY0 Remit Posted Y 0 1 Re-Inspection on or After: <br /> I70tclea^a <br /> u -I Id-u lush mtl c ; <br /> fIJ c is c <br /> f o /� c �'�2v to r C t/u <br /> Te P, 67n US') h6- Ve <br /> ern 'n Y1G 44 If KC cl <br /> ''Food Safety Cert,4 ; _ <br /> Name: _ Hand Sink: "F hlorine: ppm eat: "F <br /> Exp.Date: - arewashing Sink: /a f of uat.Amm.: ppm Cher: of <br /> Received By/Title: <br /> EH Specialist: _ Phone: y. 3/ <br /> ime in: / Time Out: I , y y v Page of Z <br /> I• <br /> EHD 16-24 (2n0 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />