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SAN JOAQUIN COUNTY <br /> .X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.smq0v.0Lg/ehd <br /> 4C1FpA� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> If Name of Facility: _t_5 U rQKf i 0_� Date: 04/1(p <br /> Address: U'2) S fv "' 0 city: '!MC*.�rJ Zip Code: g5�1G� <br /> Owner/Operator: 11 v "1"lN C, 1 v Telephone: "-1 c o(i5 <br /> Program Element: Program Record: Gia (i Mr-1 Inspection Type: �- <br /> 1 <br /> IS B180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑I Re-Inspection on or After:wm <br /> �............e� I <br /> � 1JI c C,1hG� Oif i <br /> - �A(An0 �nU\PJCkW C+ CU�Ala'�n� <br /> ppb v .eci s 1 a C A�- QriC) C) CUL66S <br /> V�d See SCO VH R C5f1 IYV- GS'rt G , <br /> MUna -FSS CAq cmc e G <br /> wee' <br /> tAC11�G� C1.e Tt�� IU CG'S�eU w i"Ch <br /> 6olufiic> (-CA- Gqd \-u ri"-1 <br /> wi~Ch G &'01 UI c 14 . c)sr t Hifi <br /> G1-e0nl pAcx,4 Gr.eG vAcgye -f-se <br /> I m <br /> , ii tete t cit. °+mpeFa . <br /> — — --- - - _ --------- ------- --------- -----_— <br /> i <br /> ...gym d, <... ......» .. <br /> Name: Hand Sink of Chlorine: ppm Heat: "F <br />} Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By I Title: �-- <br /> EH Specialist: Phone: ,y-s � �2 <br /> ime in: �. Time Out: 1w.'IU U Page of <br /> a <br /> EHD 16-24 (2ntl pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br /> 1 <br />