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SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT' <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> 4Likoa�� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Wto— Date: r✓Z Z� v <br /> Address: Xs/ 8 City: 14 Zip Code: <br /> Owner]Operator: " A eN� 7 y R (I)Lk-114 <br /> Telephone: 1 . <br /> Program Element: f o Program Record: �� Inspection Type: I� l <br /> SB180 Posted ❑Yes ❑ No Permit Posted ©Yes ❑ No Re-inspection on or After: <br /> EMM%=01_�A fU u IMIGN <br /> v*t C <br /> It m ocatian rr►.e 'ur m 'Location =ecrrperat le 0catio1:1 =ern erat re, <br /> ooSa#i3 . �ertficatio. ac't' `':o• mater rtemAerat r jJllaxew s <br /> Name: Hand Sink: of Chlorine: ppm Meat: -F <br /> Exp.Date: Warawashing Sink: of Quat.Amm.: ppm Other: of <br /> i <br /> Received By I Title: <br /> EH Specialist: Phone: <br /> Time in: trTime Out: r Pag of <br /> EHD 16-24(2^'pg) 111109 FOOD PROGRAM OIR CONTINUATION <br />