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� - QF'44th• c <br />e: :< <br />4CIFbkti <br />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: www.siaov.orD/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />,,'/ /Q IV14." <br />h <br />Date: <br />3 <br />Address: 1 <br />City: <br />Zip Code: <br />Owner/Operator. <br />Ql—e a, <br />/ 6 / , <br />Telephone' A — 3q <br />V <br />Program Element:Program <br />Record: <br />Inspection Type: <br />Set BO Posted es <br />No Permit Posted as No <br />Re -Inspection on or After: <br />11Y <br />r✓�- <br />a, �vt <br />01/ <br />✓ IYL <br />W "10. <br />7flJOAt <br />h vt d <br />V1 <br />Ol Q <br />r vonr4 <br />Atila q1F <br />W -In <br />perslture <br />w <br />—11'INLY00 <br />✓(21 <br />vl;{" fi <br />Name: <br />and Sink: <br />'F Fhlorine: <br />PPM Heat: <br />'F <br />Exp. Date: <br />erewashing Sink: <br />'F Euat. Amm.: <br />PPM ther: <br />`F <br />Received By /Title; <br />EH Specialist:I <br />`� L <br />Phone: ' <br />V <br />Time In: <br />Time Out: <br />Page <br />of7 <br />EHD 1624 (2° pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />