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SAN JOAQUIN COU,.4Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .., a `p.• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.org/ehd <br /> 4[7aode+ <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: — Li—/ <br /> ddress: .� City: L Zip Code: <br /> 5+9 <br /> Owner/Operator: n V <br /> fl Telephone: ll0? <br /> Program Element:/ program Record: IJ6,g <br /> D I g Inspection Type: <br /> 81 BO Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> r n l r r a" d <br /> ro v-+ <br /> V��e a a- air r Q cis ver • laces • AJI,i - <br /> re Cny2r .r A,:I .e 11A 14 —kc IW'V4 <br /> Co e n Xi' 7 Lr tiRv�e- <br /> aG d <br /> rrrrn Ow ee, <br /> -_2{ i c a- /- -/G • 7 ram .Z <br /> � po <br /> W9 ZF ::: <br /> Name: . . longs- and Sink: /2 DF h din 5 p ppmeat: of <br /> Exp.Date: —/ _ re=Sink: 'Fu .. r PPM r <br /> ther: of <br /> Received By/Title: <br /> EH Specialist: Phone: 1733 -071? <br /> ime in: q176 <br /> Time Out: 1000 <br /> O T F'V Page/of / <br /> EHD 16-24 (T°pg) 4/3111/33 FOOD PROGRAM OIR CONTINUATION <br />