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SAN JO' AQUIN COUNTY r+ <br /> ?{ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sj_qov.oLg/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: l <br /> Ci Zip Code: <br /> Address: jr <br /> OwnerlOperator: (,s Telephone: <br /> Program Element: f_rPrograrb Record: i7�i I Q Inspection Type: I l <br /> 8184 Posted lG Yes ❑ Rermit Posted 1 Yes ❑ I Re-Inspection on or After: <br /> a� <br /> 1 Nd _i bZ -A400 inn Itl k, c C G--46G CM t ;% <br /> T <br /> V Vr'��C� C� S 1 � • <br /> 3 1S &6 Me lV �XA(0V afi 111-e licl . 0, <br /> mew jvItix , - or\ e e F <br /> f <br /> r� <br /> 0" e'R. b COC AICtGk ov e, ItLe, �6 pf-u. <br /> ok r4C_ l • 1-e crar bo-QW . r <br /> Ck i n FCee w � <br /> t1pCcx24_ec.A &n tc,= eke CA!-­aQE CCk 4 <br /> CCNe,( and gco-_ CA-SGV e mw <br /> (o 'NO IC CAIa S i tl fih L �-1 n IZPCAT-e- <br /> co'vP� <br /> cab vvrrj w/lr cootc,cotCM C_;i <br /> �r,�%a�€t ; tom : �gy riot eta4 <br /> 9-cdC cvdtP 1G11 in Codd } <br /> r $Gly or�lP x 30 r <br /> C7tt k- �U 4� <br /> Name: (Silt-41an . �� Hand Sink: �� 'F Chlorine: 0 ppm Heat:., aF <br /> Exp.Date: ` arewashing Sink: of Quat.Amm.: lJ ppm Other aF <br /> I :I <br /> Received By!Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: r� � Page of <br /> EHD 1624 (2ntl pg) 0113 FOOD PROGRAM OIR CONTINUATION <br />