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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:wvvw.s o�.or Iehd <br /> RCIFOAi� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: (O tll Lrj <br /> Name of Facility: /t l R2�1� <br /> City: ��r� Zip Code: <br /> ddress: X� �,Q/t✓ICl�1 C_tDGr tiV4_ Telephone: <br /> Ownerloperator: �,v IC r u o f <br /> Program Record: Inspection Type: } � <br /> Program Element: 1f_2fo 9 r �(o 4�0 ` <br /> B180 Posted ❑Yes F7 Rermit Posted D Yes C 1 Re-Inspection on or After: <br /> MOWj3 s w s <br /> AbLQ tau ce. 01- Stzxc r�C,-". v <br /> of .eat ���_ � G � � r��- ►cm �Q�-w�e-n <br /> I 1�t S are, .earn (06A-Q l I n CUS <br /> curt- c�` - <br /> W �A i CJ�jll"l� - Ca - �k � G�� S G'M co <br /> Of `rn <br /> ,ani- ;T tits ' <br /> ... sCr i . r♦ Farewashing <br /> I t <br /> o" <br /> Water!n1p <br /> Name: d Sink: of Chlorine: ppm Heat: F <br /> 0 <br /> Exp.Date: Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By I Titl <br /> EH Specialist: Phone: <br /> 20q time in: OYJ4 Time Out: Y _ Pag of <br /> EHL)16-24 (21 pg) 4/3113 FOOD PROGRAM OIR CONTINJATION <br />