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SAN aJOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> i•., ;a Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> aclit}yYt�' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: U - Date: )-/)- /2 <br /> ddress: �1 2 U) G r, k L, r`a City: 'Tr o r zip code: 907C <br /> Owner/Operator:) Telephone: <br /> Program Element: Program Record: Inspection Type: ROW 4 ,n � <br /> Set 80 Posted Yes No Permit Posted Yes No Re-Inspection on or Atter: <br /> I aN1er� <br /> re s # raorA lac KS SOC. err C, dc; reef- <br /> fOL n K e r i nerd Wps bra ; � � �/u UreCL,Cs <br /> k ; I -'4 b VG A 3 i A " t c h1v In <br /> G lean 40 del <br /> Iq o e_ie L. a Ie // <br /> 5i�ocd 0 rc, dier J ; n he 4 4 <br /> 14 av d 101c, Kj r , <br /> 6 rd ✓ td a MCI n of If r cor to l/ o <br /> co r i r .5 <br /> i 4; on on S <br /> N04 I t F /oor ; +o he A rY1 a need 4a be� <br /> r f re A eor tlA 4 r . <br /> GOrdo.cr -coroo 40 r JK-; nF <br /> IN ame: 's 0 1 e VPand Sink: U `F hlorine: Ppm set: ;,20 -F <br /> Exp.Date: / I arewashing Sink: I of rust.Amm.: 11 v PPM ther: eF <br /> Received By/Title: �,�� 0. <br /> EH Specialist: Phone: ��� <br /> Time in: I �.� Time Out: •� Page jof <br /> EHD 16-24 (2-pg) 1112/09 FOOD PROGRAM CIA CONTINUATION <br />