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SAN JOAQUIN COUNTV� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sioov.org/ehd <br /> A/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J -: Date: z .i 2 <br /> ddress: O ( Ih + City: TracZip Code: q537 C <br /> ner/Operator: Telephone: K3U, -7 Lq50 <br /> '7 J <br /> Program Element: 1 UG ogram Record: Oe U 3 'rS G InspectionTyped Y✓) Ir, r) .r <br /> 8180 Posted Yes _ No Permit Posted Yes No Re-inspection on or After:( <br /> ERVATIO <br /> !Yl kole5 - izI) no moldy Or an'• rc Ce. <br /> TI1t, i• r -d LACC vas q re 54 : n r\ i3 <br /> nSGn; ar <br /> 1 t5•. o moil O bsetvad <br /> I c d L4 e S a r Ilzr An G+ <br /> ISo• Pu e• ller hos f1o � <br /> b >on re Ck, ed % n n C C v in k hs <br /> 5 CIe r. "t)d Cl.ecKPd 421/'r Tu,.Sel <br /> P.ame: Hand Sink: of hlodne: Ppm Heat: 'F <br /> arewashing Sink: of Oust.Amm.: PPM Other: 'F <br /> Received By/Title: 2 <br /> HSpecialist: Phone: it <br /> me In: 1 0 Time Out: 10: j G e�0 Page of <br /> EHD 16-24 12'^Pg) 1/181112 I FOOD PROGRAM OIR CONTINUATION <br />