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SAN JOAQUIN COO <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> VX :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ...cq a`p.. Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.slgov.orq/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 11 c S 1m(Z C:Oc Date: V Yllf Zip Code: <br /> --- <br /> Address: 2 S \ 17 �J City: C. G ► r 1 <br /> 25 �{ J <br /> Telephone: <br /> Owner/Operator: `I ,� -1n^� <br /> rt <br /> Program Element: Program Record: U `GG Inspection Type: f1n-4e - <br /> SB180 Posted Yes No Permit Posted es No Re-Inspection on or After W 0L `� <br /> WIN Nall <br /> AMNON <br /> A.S SUS + 0n IhC CO&U CXJr.S . C 10 <br /> (.11'( �VwA <br /> I ,Pi1�5 (A-Te <br /> 3 <br /> ( UNla- vi ve S h O Uva an ui r - <br /> Air find - c u <br /> U ci <br /> n int 1 _ cm <br /> iS f . Uwlwf -1S huw usi <br /> C all <br /> b -2 GrpCA <br /> C � i� ' � ins r e_ <br /> �,tIL t� -cQ five o h 0 .0 1 } <br /> SrItJM <br /> -ivl q of snoif1Sic G� c\�s CcJr�re �k Gt <br /> tvw c moo -\ <br /> CWCN- nom' <br /> aenS 1 4c)f <br /> Name: V ',I 77HandSink: UUof Chlorine: ppmHeat: OF <br /> Exp.Date: 1 �— �g Slfk: aF Quat.Amm.: ppm Other: OF <br /> Received By/Title: M <br /> EH Specialist: Phone: "�c'CJL� (p <br /> Tim <br /> in: Time Out: v Pag of '2 <br /> i2 <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM ORCONTINUATI01 <br />