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SAN JOAQUIN COUNT-r' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ... a Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: W 4415 U Date: _ a 2- <br /> Address: <br /> Address: L,. S City: Zip Code: <br /> Owner/Operator: v a (.•��r�-`�/ Telephone: <br /> Program Element: Program Record: O 5 Inspection Type: <br /> SB180 Posted Xyes No Permit Posted Yes ❑ No Re-Inspection on or After: <br /> DVI. -VN O ¢- <br /> 00 h 0-s5 o 5 - <br /> � / <br /> Q,c - `ti A Go - cmk r G�•n f. and <br /> S Gr. le-a <br /> - .ems uln�elVLea r +a' Itr <br /> ediskWA ,-r <br /> rS d2a rc� �S- ro 1 <br /> ouk <br /> M a l Fe-m a Ie �s re k� <br /> r - r I T <br /> aH s. -0 r' rzzt <br /> Sagu 20-oPim t <br /> ax 3/9/`� koe sw sso `f Sv -.rime -/ado-o r 'Yoof <br /> loar 17u-f- F Lr <br /> o f- l' nrl: F i ° -a T <br /> Name: / Hand Sink: D� of hlorine: /00 ppm eat: of <br /> Exp.Date: p _ \ arewashing Sink: =F uat.Amm.: ppm Other: -F <br /> Received By/Title: O <br /> H Specialist: one: <br /> me in: �O Time Out: �7 _ 3 p Page of <br /> EHD 1624 (2m pg) 11/2/09 �1 v FOOD PROGRAM OIR CONTINUATION <br />