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r- <br /> �ota .�dG SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �.. Telephone: (209) 46$-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> p <br /> 4(�Fp? <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: =F/2 <br /> Name of Facilityn noS <br /> Address: C� t fit ZipCode: <br /> � �. <br /> q�2.aS <br /> Owner/Operator: govLJ (-cAe j�c) Telephone: <br /> Program Element: (a Z�o Program Record: O t�0 Inspection Type:3 p'o <br /> 6180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑ 1 Re-Inspection on or After: <br /> 0118$1_1 M �� � � <br /> y i alit ho co C fZ <br /> S\AbM'+ 06110, - 170F P�+ s ss� <br /> ( IT CA- -i OC)a\.f � <br /> tae i€ t . th <br /> I[ lturs <br /> a�sd.. .. ter°1tterTenap*lt ;;,. 1ittrai <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: "F <br /> Received By!Title: <br /> EH Specialist: Phone: 9-60 - 4(00 - 3 ,440 <br /> Time in: O0 Time Out: 2MV— -'� Page of <br /> EHD 16-24 (2nd pg) 4013 FOOD PROGRAM 01R CONTINUATION <br />