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° SAN JOAQUIN COU Y <br /> 2� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �;.; ;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s'gov.orq/ehd <br /> �iFpRa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: A Date: _/ • - 5 <br /> Address: Z 0$ I �+ City: 5+_oc-K--b n Zip Code: 5 2.4C,•7 <br /> Owner/Operator: ` rl+ , _1 •_n 5 Telephone: '4�7$-5552 <br /> Program Element: (�t 5 Program Record: c P 2 0I (O 9 Inspection Type: <br /> V-918-0 <br /> Posted D Yes ❑ Rermit Posted ❑Yes ❑t Re-Inspection on or After: <br /> am j,. <br /> 3 <br /> .. Y...:.. . .;... .;a. <br /> f nY Coen-Lev- 6 — u- Gt 1'Y7�L'+ 49 CIO- <br /> (,n 5 W h G - �'L01 r -� V�2 GZ r <br /> +-y--a_5 6 G P t-e� M4 LR_ CX c�-z Tl-r <br /> . • <br /> (14_m0 V'2 C. ft of bo►met -C a <br /> w Kat— d n d4-e Y- F o <br /> ✓ 4-P_ v.\j r i"s rLo c.";, � CQ � s <br /> V- -�-o cf Y• ►2-} <br /> pop <br /> H �a �1mh � wyp 1�llr"Ir <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: of Quat.Amm.: ppmOther: of <br /> Received By/Title: WK LXA YAG yj C9 `f h <br /> EH Specialist: - Phone: <br /> Time in: Time Out: Pagel of10:0 5 <br /> / <br /> EHD 16-24 (2ntl pg) 4;3'13 FOOD PROGRAM OR CONTINUATION <br />