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SAN JOAQUIN COUNIN.-,� <br /> { ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ..c�R. .�; '• Telephone: (249) 468-3420 Fax: (209)464-0138 Web:www.siciov.oM//ehd <br /> {rFaR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: j Date: Z'7 <br /> Address: vn`� f City: �1 Zip Code: R 33 <br /> Owner/Operator: I r Telephone: <br /> Program Element: 1 -z Program Record: S2--+ <br /> Z� 5 b l Inspection Type: <br /> 8180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After. <br /> N � o <br /> JTZ tr � <br /> .ASk <br /> LL�'L%� <br /> 123 <br /> SVVI--Q C61VII A, AAS <br /> r <br /> 3 <br /> s bo�"nr�@ gYv�c , Gnr� <br /> r , ; � <br /> r- ------ --- - `fie -- ._�_r_ _. _....... <br /> _ <br /> c <br /> l�xosf, �� ro FF€ttitVreetat , : tt� <br /> Name: Hand Sink: 'F4Qu <br /> orine: ppm Heat: `F <br /> -Q..t! - 1 _ —.. <br /> Exp.Date: rewashing Sink: oft.Amm.: I , ppm Other: -F <br /> on <br /> Received By I Title: 1 r_\( ,�j�^ SO `1 <br /> EH Specialist: RT "` E� "'vtf Phone: <br /> ime in: time Out: Page of <br /> END 16-24 (2nd pg) 4013 FOOD PROGRAM C I R CONTINUATION <br />