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SAN JOAQUIN COL t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> L%FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: --jlv ;ape& 4 Date: q/ZV I U <br /> Address: Z 2 C t puck City: r. z� Zip Code: <br /> 1 C1 Cu <br /> Owner/Operator: 1 nn lCA Telephone: <br /> Program Element: � 'Program Recor 1�' 0/, Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No U Re-Inspection on or After: Cck 11 <br /> .w n -''A �, .- stt#r .m`•� ` via: ,p \;:. <br /> a <br /> r <br /> L VE V <br /> TvLex 1-6 CW I\n k mo S\"V_ has, ,Out Cod i <br /> d\aomnq &tuvq- k-erAn and tiL)dU yLaW cjlncKn � f WA A <br /> 4- 2�F . Mme\ i cS ,2�� <br /> Gk- <br /> CAA � <br /> �--z o r)� n. \U CJS \,�fi6 c oau t- vAert nu'- ac-h ve-v <br /> 1 <br /> nee a 1�hC (n i nG . C�Crec.� c� Scx�r <br /> U� us i 6k <br /> (6-z nes ove Want . gc,ur� da <br /> lc Ckhc,(IeA 011 a SPCX S k u v 1 Cf- kAq+ .r . <br /> U 1 S v-�- +oud , vlocz co o zo S <br /> Name: kHand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of IQuat.Amm.: ppm Other: of <br /> Received By/Title: UL) <br /> EH Specialist: Phone: aoci _ r^� <br /> Time in: Time Out: 2� Page�f <br /> EHD 16-24 (2n°pg) 4'3;13 FOOD PROGRAM OIR CONTINUATION <br />