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SAN JOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
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<br />Address: City: Zip Code:
<br />Owner/Operator: Telephone:
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<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
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<br />Phone: r-2__. ko I b,...„ 0,..02 EH Specialist
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<br />EHD 16-24 (2^d pg) 4/3/13
<br /> FOOD PROGRAM OIR CONTINUATION
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