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o4a'1=N. SAN JOAQUIN COUNTY <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 'c-0._ m �;�p• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s ov.or /ehd <br /> Li i�pR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: [ tll 1� 1pmv. _ Date: Z���to <br /> Address: 2�2 d TVA i( ft; ( City: cI-rJ Zip Code: ?o <br /> OwnerlOperator: <br /> Or) <br /> �� r3,.' Telephone: <br /> Program Element: i �,Z Prografn Record: <br /> s���l � o Inspection Type: p , rve <br /> 6180 Posted 1 es U Permit Posted Yes ❑1 Re-Inspection on or After: T� � <br /> ... <br /> ANr::: <br /> l T1�re Gr G o _E i eS (a _ Ifit fab li <br /> C�hCa M VAel-) - PS (CX)trzA <br /> 2 SGrM.2 �� �� GI�� 1� Ix��e Cie . C�eu►�_- t <br /> I CMS - crr 0nj mod 1tnln la-v Si+C <br /> €, � r � � <br /> M (P &InK - <br /> C;r d �5 ---------- -------� - <br /> .-_. ._..__C a. -lam----------------------- _ ...._..---------- <br /> Ir <br /> Fuad.',. -�f �3 ;I�i�iCl �Wati:r:TenaL1 i 1lVara�+lt, ii; <br /> Name: Hand Sink: I (� of hlorine: .��j I ppm Heat: aF <br /> Exp.Date: i� arewashing Sink: `I Ci of uat.Amm.: ppm Other: eF <br /> Received By 1 Title: YJ — v <br /> EH Specialist: ~ Phone: G co ! -6 <br /> ime in: Time Out: Pageof"� <br /> EHD 16-24 {2ntl pg} 413113 FOOD PROGRAM OIR CONTINUATION <br />