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SAN JOAQUIN COU:wY <br /> .z` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t )o.} Date: C 2 3 `I <br /> Address: S,?G Gr c! V}py} City: �S{ ,en Zip Code. <br /> caner/Operator: J a r u L Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> Isla <br /> B180 Posted Yes l No Permit Posted Yes No Re-Inspection on or After: <br /> 08SIERly, <br /> - .. p c= eel i\ A; 4 ex3 _ 3l - Irl <br /> v k _-- <br /> 0 b ✓1G ( qtr - �t?QS df1: erproJ 40 OLA)Ae - <br /> --ILrL C4 c 1; 1� +��s _ Cto se - <br /> C D U S CA �[ <br /> �GiFitilr' <br /> �anfr2re �t�tnt101r1. 1 1~ atu <br /> t=rod <br /> Certifie#urn Fit tst- aiti f e P .. 11Arewashi ; <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm ther: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> 6d':T/6Y <br /> Time in: a; 3 Time Out: , Z Page, of , <br /> FHD 16-24 (211 pg) 41303 FOOD PROGRAM OR CONTINUATION <br />