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PpUtfy SAN JOAQUIN COU t <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> a <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq., iP Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.siAov.or4/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 7j rJ�� Date: <br /> Address: atp W L+ City: V+V +0r1 Zip Code: 5 20-7 <br /> Owner/Operator: e �) _4e 5_ 3�6 Telephone: 475_'56-5 <br /> Program Element: I�2 Program Record: P R 05 1 (v5 9 Inspection Type: v-H r? <br /> 1§6-18-0Posted ❑Yes ermit Posted ❑Yes l Re-Inspection on or After: <br /> t r+0 W_e-1 nso Us S .. owr ry y - <br /> r <br /> 6000on ' 1.p- Le- I Oo 'U r )ii' > >.o r . <br /> 1—, CA LA-4%✓cr C.S yrio • o V-1- Aw <br /> LC�j yn - C rL S (A Cr-tc—, <br /> rA <br /> ocr h�, �i,�✓ CAO r c3--3 c( -66'0 a ynat n Q r• <br /> Ce,l' ye- v <br /> Le 'to h r C_ Z "Z) <br /> Yd <br /> r YY't!�L i LJ2A V-1?05 A-A- C.cs rY\e ry-kr W r� �- a► 5 � 18 �PS tO s hcvu <br /> P�ba,ce_ a 0 i's w l-e_ U cot- al i cu_,-> +c)rx e r <br /> 0 UJ,?-4- +D w Co r . �� 0. u c�IC e•- <br /> (.V 4� to Y i <br /> AM, c;1.m n W..ej5 -b ntd L", <br /> a. GtA-A n a Lt- cA n 4-c4�,..�� <br /> r <br /> t <br /> I r h rV-1,0 n.e.. (4l <br /> Name: Hand Sink: of Chlorine: C,, ppm Heat: 'F <br /> Exp.Date: Warew hing S k: of Quat.Amm.: c� ppm Other: o f <br /> Received By/Title: <br /> EH Specialist: Phone: /, l <br /> Time in: O Time Out: , 410 Pagwf <br /> EHD 16-24 (2nd pg) 4,13/13 FOOD PROGRAM OIR CONTINUATION <br />