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�,,,,� SAN .IOAQUIN COUNTY <br /> ?q c°c <br /> r: sa ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (2p9)464-p13$ Web vrvuw.s ay.or lehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: <br /> j Name of Facility: l City: Zip Code: q S 3 <br /> f ddress: CA 2 � � �j- �[� Telephone: <br /> �� 1iS <br /> Owner/Operator: {� inspection Type: <br /> Program Record: <br /> Program Element: 1b1� <br /> p Yes ❑ Permit Posted <br /> ❑Yes ❑E Re-Inspection on or After: <br /> 8180 Posted <br /> ` MA �� r <br /> Nr-e-. <br /> - � CVSLI. <br /> C ` L.n T ' <br /> t � <br /> ..:f,FFiti�'{R A!��•'S �.t� � ..,tet ..m.V. i��1:i11.���Y,S"., Yffi�si.it <br /> C <br /> � Bti�E4€srt_' B±✓i1 • >• ICauEltll... <br /> Name: Hand Sink: `F Chlorine: ppm Heat: "F <br /> 1 <br /> Exp.Date: Narewashing Sink: -F Quat.Amm.: ppm Other: `F <br /> Received By!Title: h" � (Z p ei- fl �/ Zo? T/S - 3 3 BS <br /> i K-1 rV Y <br /> EH Specialist: Phone: "A � O 3.1 v <br /> v1 <br /> Time in: 1�7 , f Time Out: 1'.01 <br /> ' 04 Page of , <br /> EHE 16-24 (2ntl pg)041,13 F00D PROGRAM OIR CONTINUATION <br /> 31 <br /> a ' <br /> �� ��; '�-.-2 1'c".�2�—� 5�5cr%� I-�o( pc��Y •�U C�rc���v�� ��Gt O 4�c� <br />