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SAN JOAQUIN COUN. <br /> ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.oro/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5 Date: <br /> ddress: 3 U I �\. r N + L.n` City: ) r N r Zip Code: <br /> wner/Operator: W l Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> 8180 Posted Yes ❑ No Permit Posted es i No - Re-Inspection on or After. <br /> rUV� <br /> 1 J i/Pr Crac lln / n 4CAen " P ),a re i n <br /> 1 <br /> 1 <br /> cover u KrrI ; n h 0 ad roy, c1c in <br /> e Ks. e J r) <br /> 3 P; 2 bcXP o ►. i '16cr. e 1 , oc, ae /1 <br /> r :f vc {5 a <br /> PG 40ola RP0101 vocia <br /> or n Kj i nn i n deem 102c,0 )ar <br /> in a <br /> tea: -25 c I h a Ad Ca 0 <br /> 6 �rGVI S r d ( r <br /> re C 2 lt) <br /> d rv) a n a -1 , <a 4e e xp rn3 )h; t <br /> Name: S 4jP n ban :e Oe VI/ and Sink: q6 ofhlorine: Ppm eat: /O q of <br /> Exp.Date: I arewashing Sink: 1 O of et.Amm.: �I_ Ppm ther: of <br /> Received By/Title: <br /> �cGl <br /> H Specialist: Phone: <br /> Time in: ` O� SS Time Out: o O Page of <br /> ZI <br /> EHD 1624 (2b pg) 4/9/12 FOOD PROGRAM OF CONTINUATION <br />