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SAN JOAQUIN COUNTY <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �°t!i oRa:P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.siqov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> ► 41,1, date: 3� <br /> ddress: <br /> City: Zip Code: <br /> wnerlOperator: Telephone: <br /> Program Element: P ogram Record: S Inspection Type: - p <br /> 611iD posted 0 Yes ❑ Rermit Posted ❑Yes ❑ I Re-Inspection on or After: C� <br /> C ce <br /> cit ll <br /> 1-�J W�_ <br /> e Gvc, cGuvk =/, Fr` Y � , <br /> .— <br /> 1vri 1n c ply <br /> Jf e- <br /> �4� i �C tss3Aar'1 irs #i <br /> Name: and Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm they: •F <br /> I <br /> eceived By I Title:H Specialist: lei Phone: <br /> ime in: Time Out: y !S Page of <br /> END 16-24 (21"pg) 413113 FOOD PROGRAM OIR 70NTINUATION <br />