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"we SAN JOAQUIN COUNTY <br /> ag a. ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www siaorehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Ewner/Operator: <br /> : -�' ,(!R Ci I F �.L.Qt 1 zip code: q Gj2QS <br /> city: -U 1 <br /> )O toa IN W fISdn w Telephone: b2 ,32� 2_ <br /> nt: 1 C� Program Recons:❑Yes ❑ Kermit Posted <br /> ❑Yes ❑1 Re-Inspection on or After: <br /> Fac l l i S w 1 rhG1 t 1 U ?)Of M t <br /> - ThIS 1S A N f ct\i <br /> CaMQ i- Q SU MI IQ0( . a NeAv <br /> -FfJI U 1 i <br /> ame: and Sink: 'F hlorine: ppm eat: .F <br /> Exp.Date: arewashing Sink: `F uat.Amm.: ppm her: 'F <br /> Received By I Title: <br /> -� 9 �l'! a � 0 <br /> H Specialist: Phone: Up -40c6- 34 (o _- - <br /> ime in: ;3o Time Out: Page of <br /> EHD 16-24 (2w P9) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />