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eR " SAN JOAQUIN CO&i� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> �L iii � Telephone:(209) 468-3420 Fax: (209)464-0138 Web'wwwagj ov.or /Q_eh-d <br /> FOOD PROGRAM OFFICIAL INSPECTION-REPORT'' <br /> Name of Facility: Date:. <br /> Address: S o h ,, city: xh zip code: -.,G s tot G S <br /> Ownerf0perator: f FGc S Telephone: <br /> Program Element: t bQ :Program Record: C 00c) . Inspection-Type: CG 61 <br /> B180 Posted ❑Yes ❑ No V� Permit Posted ❑Yes ❑ No Re-Irispection do of After- <br /> C-01 <br /> fter:Ca 5 ale S— 86 w" <br /> �I 4 J f 1& ti) <br /> I d $ I KI Clie Q h c[ r1151ro` <br /> S 1e 1f S. e 0 /lel 4 S+lr, c �he-. 4Arn <br /> S5(A + 5 re5utveDr fl8a+^s Are <br /> wo, tor- ro5tared, CA for re- - /•'r.or, . 'o <br /> d n tr0, � 844145 S M U a C 11Qcr! <br /> �0r Sul <br /> P uj aFa1 n n i Yt�o ur 1C;h <br /> Call LW - 3 9 2 o or C4 ►^e i ra Pe,c41'00 <br /> G4 c. P IL, M bee- ov�e da uh <br /> s <br /> Name: and sink: of Chlorine: ppm Heat: •F <br /> Exp.Date: arewashing Sink: "F uat.Amm.: ppm ther: 'F <br /> Received By I Title: C Qtr <br /> EH Specialist: Phone: <br /> yba• 3J y <br /> Time in: p Time Out: fa: Page jof� <br /> EHD 16-23 (21"pg) 11/06108 I / FOOD OR WNTINUATION <br />