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SAN JOAQUIN COUN <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ..i �P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.siQ /ehdov.org <br /> � FpRa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: (��� (Jt l �1 �� (- Date: 1 <br /> Address: v� �J I \ City: Zip Code: i <br /> �U C,t=-t <br /> Owner/Operator: C,on Telephone: GJ(V 2 UC) <br /> Program Element: I (G2 Program Record: R�, i� ' G G1 Inspection Type: t7( <br /> SB180 Posted El Yes ElRermit Posted l ❑Yes ❑1 I Re-Inspection on or After: <br /> SEEM <br /> 1 hW i S «CJS Qi Cn IAe f"s Co S�+eS <br /> C�Uzctn S US est b <br /> ahCA 12 i -bf-(� phin C)& - <br /> 3 SSG C'e i vl h JD lil - X fio lkL '0' <br /> 'b1-co ' D\Ae u <br /> a CM\ CcrMM O/r CAO) CA7 �2 uran�- <br /> vvOCO— <br /> E7 i ,n P.rS CP <br /> (CC) <br /> 1c`F ___.... ._..__ ........ <br /> \1S MPS n _ 13�`�7 <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: � <br /> Time in: Time Out: Page�f 1 <br /> EHD 16-24 (2n'pg) 4!3113 FOOD PROGRAM OIR CONTINUATION <br />