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SAN JOAQUIN COl1tCfY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> _. � Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.orC1/ehd <br /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Y C-i+�t� Date: 2 <br /> Address: r City: e -�-an Zip Code: 91b aO <br /> 401 r > +� <br /> Owner/Operator- Telephone: L(�o_,5-2400 <br /> Program Element: I CQ?.E.r Program Record:, P P-0 I (.o 0.$�3 Inspection Type: ` — <br /> B180 PostedrYes L No Permit Posted JYes -1 No Re-Inspection on or After: <br /> h 4_ (�4.y-c r Ls <br /> l'roV-F, (j c.. j -e— <br /> r �- <br /> t ?eta rature t. #rli Tem ttli f#drr3/-Li�ktton: Temperature <br /> l thm yr r <br /> Fd,S .. Y CeatiorlliYllt �e, iareFre is+asts�n <br /> Name: en s �� Hand Sink: //r1 L JO 'F WgEe1� !j)a Ppm Heat: of <br /> Exp.Date: arewashin Sink: T j2 of �aY� ny ther: of <br /> Received By/Title: <br /> EH Specialist: Q� Phone: q53—78 1-2 <br /> Time in: I O,r rJ Time Out: J *4325 Pagt;'of <br /> EHD 16-24 {2k pg} 0112 f FOOD PROGRAM OIR CONTINUAT{ON <br />