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.guln. SAN JOAQUIN COUWi <br /> o. .�aG <br /> ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> • 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> P. Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sioov.org/ehd <br /> qCi F ORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,� e I Date: 2 -/.1 l <br /> e u h <br /> Address: r LI^ City: 7 N r zip Code: q s U <br /> r <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> g g "1 <br /> B180 Posted 0 Yes 0 Permit Posted Dyes 01 Re-Inspection on or After: <br /> O i <br /> Cn'p,,el�4 <br /> rame: I/ d Sink: I 3 =p hlorine: PPm eat: =p <br /> vate: arewashing Sink: 'F uaf.Amm.: ppm ther: 'F <br /> Eeceivedtle: Phone: 29rf/6'0. y 3 Time Out: Sib 0'5 f PagAof <br /> EHD 1624 (2n°pg) 413113 O FOOD PROGRAM OIR CONTINUATION <br />