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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. ;P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.siaov.org/ehd <br /> ,A�FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> ddress: d-:'".3 City: Zip Code: <br /> Owner/Operator: L uA^' Telephone: <br /> Program Element: i »-.l Program Record: Gn-.1,1/ 1 fj O C Inspection Type: <br /> B180 Posted I V v❑Yes C Rermit Posted V vv❑I Yes 0 IJ Re-Inspection on or After: 7 <br /> L <br /> IA4 A44i <br /> ti <br /> Gt' DtvtGc <br /> S.11 Ria ',� AJ <br /> t/1AfX/u riOAC0( ov- Y1,4.a"o/ - d ^ <br /> Mtk cF ✓ _a, , ow __ <br /> vt_..r-e al - - - at� <br /> 1~ <br /> WS- d AAA, AQ4 Y%Vti <br /> DF <br /> 1 <br /> (Ce v` .l0 3 GLfPQ Llt nwl &nvu W9AW" <br /> Name: Hand Sink: 'F hlorine: ppm eat: 'F <br /> Exp.Date: - arewashing Sink: 'F uat.Amm.: PPM Other: 'F <br /> Received By I Title: <br /> EH Specialist: - Phone: <br /> ime in: i - Time Out: Page o <br /> EHD 16-24 (2-pg) 413113 FOOD PROGRAM OR CONTINUATION <br />