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SAN JOAQUIN COU'__ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> W p.. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT i <br /> Name of Facility: r +. <br /> Date: <br /> Address: I Q ,,t r �]ATOL4ker }�.L City: +b +may Zip Code: a 5a0 <br /> Owner/Operator: W 4-en Telephone: 3_a60 <br /> IOU 1 1 60 =n c� � <br /> Program Element: loot r 5� Program Record: S R O Inspe ' Type: F1 P14- <br /> B1 80 <br /> 4B180 Posted ❑Yes C] No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> -� ilERva-rIONS <br /> i71 ? ©RFiGT� <br /> ". <br /> OW gt <br /> r P7 OpeL7 r <br /> r . - un <br /> r . <br /> r-Q c�r' c� rr <br /> re <br /> ' e Q rx2r 54a1c� vn-6� '-/ 1rD e c to G;`. 3 L Y7cl'7 <br /> ra eiiusrn .e 0* loo r <br /> TISI-0 re rn 9F <br /> /r r % iJ7 <br /> L . r <br /> 7� U + J 1 h <br /> n s;/_s a r U. A74 v9 <br /> ande- O'r r <br /> 6e het!�2 <br /> u S� <br /> r r �.t'•z s 5 ha LL 6�e_ r� v�r'a(� be c <br /> ✓id QLr t U-e Y .y C10 C4-)S <br /> , <br /> "' erature� Locataon Tenn erat�ire's <br /> y_ <br /> }tILocatuzn �# <br /> foodSafet ,Certrfiutu3ti Facrl MotlNatrfierls eratur SNareuvash�ra .... ::- <br /> Name: Hand Sink: / 'F Chlorine: ppm Heat: -F <br /> Exp.Date: arMSink: 35 9F Quat.Amm.: ppm Other: of <br /> Received By 1 Title: �� rte Cy <br /> EH Specialist: Phone: <br /> Time in: o/ Time Out: D Z) Page of / <br /> EHD 16-24 (2' pg) 413113 FOOD PROGRAM OR CONTINUATION <br />