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opAk!N c SAN JOAQUIN COU" <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> r 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -Z ` Date: <br /> Address: n 6 n 1 go ifCity: Zip Code: <br /> Owner/Operator: V h li Telephone: <br /> Program Element: /, H 4�VlProgram Record::_ D Inspection Type: Dah <br /> SB180 Posted Yes No Permit Poste Yes E No Re-Inspection on or After: <br /> 1) UPR ju V <br /> W Q Ai <br /> f � Oki <br /> n <br /> aY 1 .% <br /> S.eV'� -ado Iryat �- 4t / tAd.`stn <br /> VL"C�-k yam., <br /> it GGV-C(n I V' <br /> DY OK yVVOVLQ� <br /> d GZ+"Q <br /> Vp( r <br /> Name: ,ww /1 ;Sink: of hiorine: ppm eat: eF <br /> Exp.Date: nk: '1 eF uat.Amm.: ppm her: of <br /> Received By/Title. <br /> Phone: <br /> EH Specialist: `� <br /> c ark1 <br /> Time In: Time Out: Pa9- G2 <br /> EHD 16-24 (2-pg) 11/1109 FOOD GROGRAM OIR CONTINUATION <br />