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SAN JOAQUIN COUP <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 /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L U /-I t Date: 3 _ ! J j <br /> Address: 'II I 0 r w d U City: f P n H CG Zip Code: 9s2 3 <br /> Owner/Operator: Telephone: C 2,(> I <br /> Program Element: Program Record: Inspection Type: <br /> &A n <br /> SB180 Posted _i Yes 0 No Permit Posted I_ Yes i No Re-Inspection on or After: <br /> W.. <br /> 4 <br /> 117 .r Jr� An� � �'�r .:.�J� I .S : mini <br /> ;2 WeG <br /> l�o f* S h 104 ' - q Wcue hCt.46rlWJI7;We <br /> 6d C, <br /> ou r n I r"G <br /> U: n IS 0 roc o S 4 e. <br /> t 0 // <br /> -C&OA r G mU/r <br /> Name: / Sink: Chlorine:ChloriHeat: <br /> PP <br /> °F m OF <br /> Exp.Date: Sink: of Ouat.Amm.: ppm Other: OF <br /> Received By/Title: . <br /> EH Specialist: 1171 Phone: p �� <br /> Time in: /� .!� Time Out: o Page, oft <br /> EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />