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L <br /> o u'N i <br /> SAN JOAQUIN COUNTY <br /> Q` a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c..: P. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s�,oq v org/ehd <br /> gCjFaR� <br /> -� FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> �V 7 7 F Date: j: j`J <br /> Address: / II , (� City: �,q.� <br /> ��✓�� Zip Code: �537 <br /> Owner/Operator: I N4ve ' 1 <br /> Program Element: I ZI`r Program Record: Q �O�i Inspe • y{�e: <br /> SB180 Posted 7 Yes/❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> f L /�U 17 / I ✓¢S — � 1 k7 — l i .3 � h D jt �l t� v w� <br /> )T�-1 f€�7 P 1f� _F0 <br /> aerL S uA37,TAmc. C rtCG i/1 Wee VS . <br /> &a— <br /> I — Co W l kms[ <br /> ° ' <br /> ' CA WP <br /> S`I- -Zoos �d�- iv sc�dJ S u — <br /> AV io0 )U F 60C 013 ERAn <br /> e i rnk c : d� <br /> QY7 e r'.✓� <br /> a W1,s / OF - /l O/ <br /> — boa <br /> d�,► r — ►ti <br /> Name: Hand Sink: /f of chlorine: ppm Heat: of <br /> Exp.Date: Warewashing p 4�7of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: �V 7� Page of <br /> EHD 16-24 (21'pg) 4013 l J I_`/ FOOD PROGRAM OIR CONTINUATION <br />