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Q"'" SAN JOAQUIN COUNTY <br /> y_ X tNVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ... . :P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si-ov.org/ehd <br /> '9Ci F o'ata <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �i�c < Date: ":�/! <br /> Address: �G ftr Un c City: ' ,�r��,1�i J Zip Code: (71532�� <br /> Owner/Operator: ' x�O j u1n Telephone: 43"��� C1 qj <br /> "J'� 1 <br /> Program Eleme �23 Program Record: / FJ 3 ��� Inspection Type: -V) <br /> SB180 Poste Yes No Permit Posted Yes No Re-Inspection on or After: <br /> wus U 1 S V� c Mr oto - - <br /> occes�* Ut 11 _fC1: . CvrrecA tUccccoyf-ecAeo <br /> aCb -n s tobU Cld Q01-6 CO <br /> C-., nd e <br /> of l t� t ed ao bavv,,ocAp <br /> 4 d i' CMA Iry idS CT \N_dh U G CA-i <br /> 61/ <br /> No U11 �A t4kei s a 1- �S eco <br /> sc� s S n \-xW -�v vo--V-t-- S m (-Q- <br /> VvC <br /> �Vo r'd vvrcl GT sc •- �R iGuS YgLory C'n C, <br /> 0 Cola' <br /> Name: n1 - Hand Sink: U U of Chlorine: Y� ppm Heat: of <br /> Exp.Date: 1 arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: lJ <br /> EH Specialist: Phone: 9(`N f - •d.(G <br /> Time in: I S Time Out: 1 I Page f Z <br /> EHD 16-24 (2n°pg) 413'13 FOOD PROGRAM OIR CONTINUATION <br />