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r <br /> aq,4z4i!1�• SAN JOAQUIN COUNTY � <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • <br /> .01 ;�. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov_oralehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> [Program <br /> ame of Facility: 14 v Date: t <br /> ddress: � f �11 QAm A; pf'IL City: Zip Code: 'h <br /> wner/Operator: Telephone: <br /> EProgram Record: Inspection Type: �V1 <br /> PSI60 Posted ❑Yes © No Permit Posted o Yes 0 No Re-Inspection on or After: <br /> i <br /> r Pk-4(AL.,� <br /> Ill <br /> • ti. Pj�.E.a �, ' _ li.r` ® - 0 YWZt k l i34�1l�r <br /> e;oib PV 0 aVd- t P1 �i a(lA - <br /> C l 1 �t 'Lt1,S I IEf fr p <br /> i � I4"V A a <br /> VkA of214- afipl�10 <br /> Ly P1 tiluld o jk <br /> I <br /> I� <br /> I <br /> �i <br /> F <br /> I� <br /> f74F�` �6? .th:tea rc-R yr.. rd. 71 " <br /> 4'z- <br /> Name: Hand Sink: `F Chlorine: ppm Heat: ! `F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: E� of <br /> Received By 1 Title: <br /> EH Specialist: Phone: <br /> Time in: r Time Out: + Page of <br /> f <br /> EHD 1623(211d pg) 07129109 FOOD PROGRAM OIR CONTINUATION <br />