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ouiry @ <br /> SAN JOAQUIN COUP''``r <br /> ENVIRONMENTAL HEALTH DARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 96.205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s ov.or lehd <br /> {IFOR � <br /> I F <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> -45 <br /> Name of Facility: u - U ,� pate: [g <br /> Address: f t o q r" City: Zip Code: <br /> Owner/Operator:—1 —t y; Telephone: <br /> Program Element: Program Record: O 521 D O Inspection Type: <br /> 13180 Posted ❑Yes ❑ Rermit Posted ❑Yes Elf Re-Inspection on or After: <br /> ow, M, <br /> �E � am <br /> r. •. ..m. .m �. .: ...,� , <br /> h <br /> fipo <br /> � iAt <br /> i <br /> -d std <br /> PUtlUrW <br /> rs�t � TJ/-mIw <br /> .; :It�i °�r�c�tFt'!t>" <br /> GC CA <br /> I YI V C 4- qMkkaS <br /> dttI4 # tiS afrTn <br /> Name: Hand Sink: D `F Chlorine: /1 ppm Heat: of <br /> Exp.Date: arewashing Sink: -F puat.Amm.: V ppm Other: of <br /> f <br /> Received By 1 Title: <br /> EH Specialist: Phone: <br /> Time in- Time Out: I Paga1 of <br /> L� <br /> LHD 16-24 (2'1 pg) 413113 FOOD PROGRAM OR CONTINUATION <br /> •1 <br /> !3 <br />