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qurp SAN JOAQUIN COU Ily <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •'ca ... .:a w'• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s' oy.or lehd <br /> Lf FOS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 777 Date: <br /> Address,. I e( City: Zip Code: <br /> wnerlOperator: 6z—& <br /> 1 Telephone: Ve_ <br /> Program Element: Program Record: / Inspection Type: M�Z `,� <br /> IS B180 Posted Yes ❑ Rermit Posted ! Yes C]1 Re-Inspection on or After: <br /> 1 <br /> � <br /> Av V Sh u-rU�� <br /> AAA JAAV�_+ 11V <br /> V�AA P 1AJAIA I, <br /> Il m <br /> �kxomz <br /> ,tAvU <br /> (rd) -AwVVmtctA Ilk <br /> WE '�V✓� <br /> ^'"•`. ''' ' `°��o�ad:�aiY��x�k# ,:.., �.-_w. ���?li ". r �' ° -....._,.v V 'fie:....:...: ... �gk� ...:.; .. <br /> Name: Hand Sink: `F Chlorine: ppm Meat: `F <br /> Exp.Date: Warea= of Quat.Amm.: ppm Other: 'F <br /> Received By I Title: <br /> i <br /> EH Specialist: Phone: <br /> Time in: ! Time Out: �Y 1 �'f Pag of <br /> EHD 16-24 (21d pg) 413/13 1 V FOOD PROGRAM OR CONTINUATION <br />