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oP4uly' SAN .IOAQUIN COL •Y <br /> �.• •.o <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> __ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �;.. ;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s'gov.org/ehd <br /> <<Foa� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> 36 04 <br /> MR 4 <br /> rgrmbv 77M no <br /> - <br /> NO ' U �, OI�' . r-O CA I,-+v feaFoo-vi tvs <br /> b&A W-V vv-Arth i Ord C-4 o v2 <br /> V6fi0a\q <br /> 1.�v oil <br /> -- Mcg ;s e n c cov:er i c c ovz <br /> -d l� <br /> b ; 'WOT& 0100 TN"Q_�. CAve S;tm ir\ <br /> on CWe-av, <br /> '77 �A <br /> a <br /> Name: rarew <br /> Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: ashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Titl�kx��i__VVYNP7___'\ 1]�L�� cooval(a�x <br /> EH Specialist: hone: <br /> Time in: U Time Out: `t 1v Page,-IV- <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />