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SAN JOAQUIN COUNTY <br /> �-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 'X i <br /> 1 868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c¢..r.�`f•.a` Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> L �pg <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: . .r V- Z-4 Date. —7 <br /> ddress: i 9 iA A!> r IL <br /> �'` City: Zip Code: 9 5?�4. <br /> Owner/Operator: ` Telephone: <br /> Q Y7 n (n h.ct� L{l0 3- <br /> Program Element: Peogram Record: co 0� 9 I q39 Inspecm 0.'on Type <br /> ri <br /> SB480 Posted XYes 0 Rermit Posted >fYes ❑1 Re-inspection on or After: <br /> Mir <br /> A : <br /> flBSERU1 T1iCC�NS'Atd© DRRkTJVE A 6NS,. .. Z s- y <br /> ger D n 3114Ie CA��- 00 rrl C� S+tr <br /> � F'1'Lit V l.t�l�� •r' �i- �'1 <br /> l e d rte e L. r ca <br /> E E V k-01 -4P b P k `,rte kil <br /> r I c® o cue , <br /> r A 4-t of `44?_ - <br /> ,S ►- <br /> ' <br /> �- 1►'! �G - C) r1 m <br /> + <br /> '-fie r►�, rr�-h.� r-�s c�..c c �-�.bl v <br /> I✓U, Lo <br /> aoL <br /> jf ``� `lte�n/l ovation , ' Tempeiatute" -{. � " ;` r3 1tEin i LocatEon ` s. :'Temperature, <br /> Et r <br /> -"17 �� � A, <br /> yx;, ;_ Foo,5a etmy- i afi fjo _ �,�' Piip! Hot WaterTemperat r� :, t arewa ping . . a• <br /> Blame.0 r � !a ! Hand Sink:�� of Chforine: Heat: of <br /> ppm <br /> Exp.Date: 2—} 4�l "F1 arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By 1 Title: <br /> EH Specialist: �M ; 1 CZPhone: G 3 r� •8 <br /> Time in: Time Out: yJ� Page,of } <br /> EHD 16-24 (2ntl pg) 413113 F FOOD PROGRAM OIR CONTINUATION <br />