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M <br /> SAN JOAQUIN COUN <br /> M: ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95295-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:M".slgov. orglehd <br /> t��OR a <br /> { <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 77 <br /> ddress: �� City: Zip Code: <br /> Y7Lp <br /> OwnerlOperator: ` Telephoner <br /> Program Element: L. 2 Program Record: ,r 1 G -� j } Inspection Type: ► 1 r <br /> B180 Posted Yes LIRermit Posted !-` es LiI Re-Inspection on or After: <br /> Y... ............... y i <br /> TIONSIOMM <br /> I )1 1 r 0N <br /> I n4 04- n <br /> 1.1 x-v'1 A TzLu.Ge,+ r cmc --c n el S i c- -1- ! <br /> Y Cm t.31 6LI Y LS. A_2_. <br /> 50 + -t <br /> rtA- rt> -e a-e-) Y_'LA_ <br /> 4-r_1--e n WvA, v� l -,- <br /> rr,)ki. <br /> t , <br /> 6 �OyY�--2. f D Y Gt 1'l�l Z� �'J` <br /> or <br /> men ckc� r <br /> A20tin ry-) OnV-e r <br /> 2�cLe ri t <br /> 6c.LA�4-e �7 2� <br /> y <br /> Ell <br /> y fto11 � Y::y. C ►a r <br /> Y- 360F <br /> Y- <br /> �N09 <br /> n <br /> � � _. <br /> ._.. <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: y �G 'F Ruat.Amm.: ppm Qther: aF <br /> V J i <br /> Received By I Title: <br /> EH Specialist: A"r Phone: S �7 <br /> 1�1M G�Lt�t�! 3 W <br /> Time in: - Time Out: `� +a� Page of <br /> r < <br /> EHD 16-24 (2nd pg) 43!13 FOOD PROGRAM OIR CONTINUATION <br /> a <br /> s <br />