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o.PA�1K• a SAN JOAQUIN COUNTY <br />?� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•-cq.. ;a• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />4�Fe'a� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: D S �Fi wvL - L j Date: _ L <br />ddress: S n % Aj I ) h 1. 6-A l%.,/ City: I /ZA . 'O�_- Zip Code: n , <br />bwner/Operator: <br />• u C <br />Telephone: <br />_-i . <br />Program Element:Pr4rarn <br />Record: <br />Inspection Tvoe::: <br />CB180 Posted Yes No <br />Permit Posted Yes No <br />Re -inspection on or After: <br />r <br />r J <br />! / / <br />I l. <br />I /- i• <br />I r ii1 � JI i <br />MKI11FA—WAN MINN. <br />VZOM <br />•d <br />• Date: <br />- <br />• !Other: <br />'Received By/ Title: <br />Z07- <br />EH Specialist: <br />Phone: �q ' <br />• %r13 <br />Time Out: <br />Q J <br />EHD16-24 (2^ pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />