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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.smgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: /� _,p City: Zip Code: <br /> Owner/Operator: U`C Telephone: <br /> Program Element: / , Program R cord: !1I/„ Inspection Type <br /> 8180 Posted i•C 0 Yes ❑ Rermit Posted ❑Yes cr❑i Re-inspection on or After: <br /> _" <br /> 14 <br /> fo _ <br /> �' Cf C -�4r.G� 0�11�i <br /> C GI! a. <br /> GYYu- vrc. C Gu Gi oL <br /> ovu a G� <br /> ZMX <br /> d <br /> J GC <br /> r <br /> hA,�AZAlr, rhW\-O ljw 6-AlrAIA, LLA� <br /> -------------------- <br /> } <br /> J✓ p e :�a <br /> ." L . m.mm..yy93•»««........m ..-�,.......9:§i�T^a�..".«V.-.".. ._myJ � <br /> Name: Hand Sink F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: of <br /> Received By i Title: <br /> EH Specialist: Phone: <br /> ime in: Time Out: i i1✓f1 Page of� <br /> EHD 16-24 (2b pg) 413!13 'J f/ FOOD PROGRAM OIR CONTINUATION <br />