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SAN JOAQUIN COUN <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232, <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.siqov.Qrq/ehd <br /> Lr�oa°* <br /> i�azl [��311 FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: DOA-V O k j S ;A V eA')t.)Z (N N Date: 2. 7-1 I <br /> ddress: X56 City: SJa �, Zip Code: q�'o2 1�u <br /> Owner/Operator: �U�7{ } 1�kUrjUn I. Telephone: 4_ SCA —232-4 <br /> Program Element: �U 2 Program Record: S R �O Cf�S ,4 Inspection Type: corm 1-tat U n <br /> SB180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> CA-Al n 00 ' CO2, <br /> Pv rnr irk Qv R-i -Ve�4- 9_00 m <br /> 1� c. htQv--oocA �r 'tn 30 S . <br /> ;eco ► ti �U-C.� "'� 'irfi�2 4"R 6'�S, <br /> \ Le_ S CC�1 rMJGGe ca C,UAn_CAV e ►rte. .. <br /> - 777 <br /> Name: 7anink:' `F Chlorine: ppm Heat: 'F <br /> Exp.Date: ashingSink: j 'F Quat.Amm.: t ppm Other: "F <br /> Received By 1 Title: A /I <br /> EH Specialist: vV /v Phone: 4 C <br /> 1� <br /> Time in: + ; Z45_ Time Out: Pagl of <br /> EHD 16-24 (2^1 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />