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Qu�h SAN JOAQUIN COUNTY <br /> 2` ENVIRONMENTAL HEALTH DEPARTMENT <br /> a: s <br /> :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209}464-0138 Web:www.si4ov.orglehd <br /> t!FOR <br /> FOOD PROGRAM {OFFICIAL INSPECTION REPORT <br /> Date: ., � -F <br /> 'of fh1 ` <br /> Address: 3 ��� City: -f-�J� ziP Code: <br /> Owner/Operator: f � � �G> (�( Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB ISO Posted Yes No Permit Posted Yes No Re-Inspection on or After: _ <br /> i Rli! TIE3 ES Ail0 `16�.: <br /> " �r Pte/ CA(4 1_-f Q C -I"7,) C VtA_E' <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: -F Quat.Amm.: PPM ther: -F <br /> Received By 1 Title: T <br /> EH Specialist: Phone: <br /> ime in: Time Out: Page yIof <br /> EFIO 16-24 (2^Pg) 413113 `C V FOOD PROGRAM OIR CONTINUTATVON <br />