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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 /> '�{jFoai� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: `� ` t [mod A Date: <br /> C A� <br /> Address: 7J` G) City: � Zip Code: 2 <br /> W Telephone: 4' <br /> Owner/Operator: �Unn j I T4 C' <br /> Program Element: f Program Record: cep , � Inspection Type: YJGN71U�111 <br /> IS 8180 Posted 1 0 Yes [IRermit Posted ❑Yes ❑I Re-Inspection on or After: l <br /> M99RWIONS ANS?GtI►���I �i� <br /> - MGn� �` UCI�R'C•� Cif __ C�►-" �1G1f1-� <br /> WC)J- \-4 Chi ��fi n hGrd& nk <br /> 'RG 11-4 V'CWzyw cwo -ow, O 50ay , OncA vc.'Vex 't eAS tzsv�e�S <br /> N&DciQeAM6 s tj jAcAAU S V1GN P_ _ nUt bQen Si o:- cN- _ <br /> v ed F z �,tn -- - n finQ <br /> wow Gt Te )OtCben <br /> h UrY�(�nk uy - vm <br /> - MUin u+n hrtsn- fved �& QnCLT-_.. ' _ -WnOk'M <br /> krait N . . trtprd <br /> KaW � S <br /> ---- - -- — --- <br /> ...-------......... <br /> --- ---------------__- -------- --- � - <br /> W in Cad . V <br /> to -040°� i . <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Data: arewashing Sink: of Quat.Amm.: ppm ther: aF <br /> Received By!Title: <br /> EH Specialist: Phone: Eoq if E�6— _ 3 <br /> time in: , 5 Time Out: Page of <br /> FHO 16-24 (2^1 pg) 4313 FOOD PROGRAM OIR CONTINUATION <br />