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SAN JOAQUIN COUN Y <br /> y, ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c.,, cP• Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.s"gov.org/ehd <br /> 4�IFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: OL 1?'e iI # () Date: 3 3/ 1-4 <br /> Address: 502 b S, *%W QCJ City: ` Zip Code: <br /> Owner/Operator: M 1 Q 1 `1"1 L� J Telephone: q 1L�_ 1-1 <br /> Program Element: T y2,< 1"` Progra Record: vv ool-z Inspection Type: <br /> SB180 Posted ❑Yes Y No Permit Posted ❑Yes No Re-Inspection on or After: <br /> Ste- q ri S - l S 1 <br /> b C w,e _ &U-Cin todow <br /> \AITR't1t hQGt1�h phi}- ho t— UV0,110b\u. M(alo*Qln G CGTkj cvi- <br /> 11 <br /> i t4 fictf mo �'Wtl �_�l L.uvV <br /> to&+ 1 �hori Cm %+e- <br /> il� T�1ni fq ,RvGII - <br /> SbG bJawy- _ I�� Iii U � <br /> R icy¢. �QcanS (46 <br /> S-o 'IF aCk C ?�e V" Wot 1-1�0 I I sz <br /> Name: Hand Sink: i(��C1 of chlorine: ppm Heat: of <br /> Exp.Date: (.� arewashing Sink: ' � of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: ?-Oct <br /> , 4r.., <br /> Time in: j Time Out: Pag oft <br /> IU- C1 <br /> EHD 16-24 (21d pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />