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o�qu�k. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s ov.or lehd <br /> �I F ljR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L-r 1 C[4p_ Date: b/k I(� <br /> Address: 3U to v-, . M U iN '!!;�v <br /> City; [� ( -HT1 zip Code: P 1�52 012 <br /> Owner/Operator: ct tot-4q Telephone: <br /> Program Element: t (to�Z Program Record: t-i c�, 4=1 Inspection Type: <br /> B180 Posted 0 Yes ❑ Rermit Posted ` ❑Yes C 1 Re-Inspection on or After: <br /> Ut RUWI od wln fi-'6CUW in 2- <br /> c <br /> c IE fib. C cA-A. <br /> Ternporatul <br /> I LHand t ter t 1 <br /> Name: ink ofChlorine: ppm Heat: of <br /> Exp.Date- _ shing Sink: of 6 at.Amm.: ppm Other: of <br /> Received By I Title: <br /> EH Specialist: Phone: /� <br /> _ `l goo..r. � - <br /> Time in: 1 Time Out: r55 Page of <br /> EHD 16-24 (2" pg) 41303 /� FOOD PROGRAM OIR CONTINUATION <br />