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�a .c'Oa N4�1 SAN JOAQUIN CONY <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si-oy.ora/ehd <br /> atl ao��� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 'T Date: /_304V <br /> Address: ! 2— !.V_ 1 / '5'+ City: —r' Zip Code: 9513,26 <br /> r <br /> Owner/Operator: _ / _ Telephone: 3 C` <br /> Program Element: ! Program Record: P/.j -�'d .0/-7 2 Inspection Type: <br /> 6180 PosteW Yes fl No Permit Posted'Kyes No Re-Inspection on or After: <br /> _. .. ::m. ... ., CTIV <br /> O61 yp, Ou F ✓ � <br /> n <br /> O ct i ° ✓ Lo w4y 1 5`� m r <br /> ),e Y_ Al- a►,t om <br /> GtrG. O n aoon4er • W),�n Y10-I- U 5i n <br /> 61prIµ F i o i el rt;-i-i z.e r . <br /> no+ h . 6 Lc <br /> of r r &m -il-- a" "tl- . <br /> Ure n �S -t- -1-c> <br /> Y o rI&T n't ho00rl'7 <br /> Het tnside, tai ✓.en+ of C?on3vtrr1-.i - io <br /> ✓-e�-rA.-k wet- n et v - n o Covter-e-d . <br /> on C2. {'1A_�'5 r,t7 ro v-' a-z- Ud S <br /> vl q -4or o+ cla-cin <br /> wt'pucs yidZw�-e K - <br /> .S 1 e t n-o Cd • CLe.cl a rte I-i t r I <br /> n i '-tierv_Pk a..4- 3-t0 waw at+ 2P . 6 <br /> Ana m tore fit- aI L -N rn-Pa &' <br /> of o L4 A, , ��e r- !az r.na--f: <br /> n r r' v 2 <br /> oo,-n .71-p '7 h o d q 7T <br /> a CLO ComA, -- d 9'r a LSOV laar �! <br /> 4 <br /> li U <br /> ety - tion Facility Hot Water Temperature _. arewashing <br /> Name: / Hand Smk- C ri e: M Heat of <br /> Exp.Date: / L Warewashing Sink: ��F Ouat. Amm.: PPM Other: of <br /> Ein: <br /> Title: J <br /> 7TOJ;3�IQ Phone: q Time Out: / b LPage <br /> EHD 1624 (2-pg) 413V13 FOOD PROGRAM OIR CONTINUATION <br />