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SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> '. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> W a�� Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov,org/ehd <br /> c,FflR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C Date: lS F I <br /> Address: 0 !1 City: I C Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> B18D Posted ❑Yes ❑ Rermit Posted ❑Yes ❑ 1 Re-Inspection on or After: <br /> b .. t13El �fiATtN14�D3RI <br /> Y <br /> 0 JP 1 <br /> V;ol6i1; " <br /> La r <br /> I v rot"n <br /> a V, olo� liG�j <br /> n►� (/�' <br /> ' (Ai <br /> J I <br /> V G Xf Qd i 1' r- A 4 i G olk- <br /> rn h ro iP <br /> Ip , G nS <br /> I <br /> m foorl:�ety' 6;3PMt�9t3er <br /> Name: Hand Sink: of Chlorine: ppm Heat: of I <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppmI I 10ther: of <br /> Received By!Title: - ! <br /> EH Specialist: Phone: 4t/ 3 l <br /> Ti <br /> Time in: + U Time Out: Page of <br /> i <br /> I <br /> EHD 16-24 (211 pg) 4013 FOOD PROGRAM OIR CONTINUATION <br /> I <br /> I <br />