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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> �••.; 4.. Telephone: (209)468-3420 Fax: (209)464-0138 Web:vmw.sictov.orglehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: d „ G <br /> Address: 4 7 0p N AS o n W CN4 city: S I K Zip Code: V:2 os- <br /> Owner/Operator: <br /> SOwner/Operator: r} J Telephone: 9s l„ C/ Cf/ <br /> Program Element: i f f o Program Record: L,) ,.� u q Inspection Type:C U <br /> S6180 Posted ❑Yes ❑ No Permit Posted ©Yes [I No 1 Re-Inspection on or After: <br /> NIM <br /> C } Seo e5o beil 0- i <br /> C_0 rA n a n J W e,5 1 e v ►, �,c; r; � o 6 d Von, <br /> r c,ch �► h , n G Vid <br /> dt\ei <br /> V: 5: 4 - r 0 q C' e 5 d r e- d r-\ C r45 <br /> Dr 1h C4r&0n Q C ey rl <br /> 1J r <br /> Trts are tA2a G <br /> O f W ° � Wes h r e-9 terfvl;hti )C)- <br /> Cc, M fs LL,) ( e G rn o n cl u 3 I C� G <br /> 7- 31 -10 <br /> Name: Hand Sink: of Chlorine: ppm Heat: OF <br /> Exp.Date: Warewashing Sink: OF Quat.Amm.: PPM Other: OF <br /> Received By 1 Title: <br /> EH Specialist: Phone: 3// OV <br /> Time in: Cy. Time Out: (� Page of <br /> EHD 1624 (2nd pg) 11121x9 1 FOOD PROGRAM OIR CONTINUATION <br />