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SAN JOAQUIN COUNTY <br /> za ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: +. X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .. - `P. Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.si og v.org/ehd <br /> 4L�FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: A57D U Date: <br /> Address: 16-6- City: 7 <br /> Zip Code: <br /> Owner/Operator: /G Telelitp on <br /> Program Element: a Program Record: Inspection Type: 12-1 V <br /> SB180 PostedVI- IYes ❑ No Permit Posted Yes ❑ No Re-Inspection on or After: <br /> OB ER�J,41 IONS AI`JD.0®F:RECTIVE AC�_�OSVS <br /> RE RL e /� Ct�T cls <br /> -_-4 z NAJZJ�jE Ws?- S F0 F- PIC o w IRS <br /> A, OB<Aiv A1 3 Ca - i,j jc <br /> n >4 13bx � L S �• old n <br /> B"Joe-Er c \LE /( co To of <br /> jMtQ-b0E_— )"WC d <br /> X) A10L <br /> , J V ori ,� oZ — ��� . — Caves Tn� <br /> CASetf od � A) <br /> b <br /> A_ L ) °F <br /> — ) � aF— <br /> / <br /> Name: �ti Hand Sink: ) <br /> )3 l OD of Chlorin L" j D ppm Heat: of <br /> Exp.Date: CJ a ar hing Sinl:V V 1 /l .F Quat.A m.: ppm Other: aF <br /> Received By/Title: <br /> EH Specialist: Phone: Y J <br /> Time in: ;I - 3 Time Out: 7 / Page of <br /> EHD 16-24 (21 pg) 413/13 `1 FOOD PROGRAM OR CONTINUATION <br />