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SAN JOAQUIN COUNIJ <br /> 2. ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> w' <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> tl� a�a Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s'gov.orglehd <br /> aR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: IcN w"� Date: (O 307` <br /> ddress: � City: S Zip Code: n 9 Q?� <br /> caner/Operator: -U� � u Cn� �Q� Telephone: �1 <br /> Program Element: L Program Record: Y7 UC) Cl Inspection Type: C(A, LA lla(WA) <br /> B180 Posted 1 11 Yes 0 Rermit Posted CL 0 Yes © I Re-Inspection on or After: <br /> V�A 1US1 <br /> OGl MU n O `s C fits ccA Ae [C) Coo ac, <br /> 1 (Je. <br /> -_- <br /> rA t e-CA <br /> T e Shck fi <br /> T <br /> > prnecature <br /> WarrelvasR:€I€g. <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: "F at.Amm.: ppm ther: 'F <br /> Received By 1 Title: <br /> EH Specialist: Phone: ,)-Oct �(^ <br /> time in: Time Out: ``��II U Pag -2— <br /> EHD 16-24 {2°pg) 413113 FOOD PROGRAM&R CONTINUATION <br />