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qPa"'N qSAN JOAQUIN COUNTY <br /> � oo <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> a: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ¢LI�o N` .. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s ov.or letld <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Z N Date: -�-� <br /> Address: �7- �/��M n S�` IL City. �tuur__l V}" Zip Code: ql)z� <br /> OwnerlOperator: �u,�O l (0"t-1 t C) Telephone: v11 G _OG A-0 <br /> Program Element: Program Record: �7p G' 3�� Inspection Type:V <br /> B180 Posted Yes ❑ Rermit Posted Yes ❑ I f- Re-Inspection on or After:SEA <br /> e <br /> rt-W, 0 V-0 �V MI�CAA eS ti n � -va CA I a <br /> �\-o . ivir eSfi Cc�1t1 QI . <br /> (10 r)i CT\ Std• <br /> i <br /> uS t 13 C1rvcaa <br /> I <br /> zoo <br /> �[hi L s� od res Nn�IW��&It C .e 'P - <br /> w��'� <br /> �U 06 cwt►F ca S �_a nom VMG,V n c E <br /> Go" . <br /> Gk n <br /> (111 w t 11 wse Took Gl SIt1k- <br /> .., w <br /> ej -VV <br /> STI <br /> ka <br /> - 3 p (rrry(y�=yip <br /> #sit �G6tartt �: -: r > <br /> r <br /> i <br /> Name: Hand Sink: of Chlorine: �_ ` ppm Heat: �F <br /> Exp.Date: WarewAshing Sink: (;Lo 'F Quat.Amm.: ppm Other: "F <br /> Received By I Title: A. i <br /> EH Specialist: 044 Phone: U -1 <br /> ime in: 1" y ITime Out: 1:� Pagel of <br /> EHD 16-24 (2' pg) 4013 FOOD PROGRAM 01R CONTINUATION <br />