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SAN JOAQUIN COL',.;Y <br /> 2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> r4..., .,...;a Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siooy.org/ehd <br /> �rFGR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: --ra <br /> Date: I_ �..� <br /> ddress: City:7T Zip Code: <br /> wner/Operator: )61-, L"4� )-7 j Telephone: <br /> Program Element: .L Program Record: 50 K) 2 Inspection Type: T7 s,LL--)f—f 1Lq_ <br /> B180 Posted 7,yes ❑ No Permit PostedWes ❑No Re-Inspection on or After: <br /> u r fi S�'�i s ro <br /> b.0— 1-2 r%rr.Lm r---'e_ <br /> ct%t Lam r o u1 I �a3��-iC <br /> foo door Y-xC+ S-eu ) n 6LZr <br /> I(,UP,e4c- <br /> tem <br /> Food et~)' anion rdS.n <br /> Hot Water Temperature <br /> ams; IF Chlorine: ppm eat: "F <br /> - _. .xp.Date: gSink: "F Ouat.Amm.: ppm ther: of <br /> ESpecialist: <br /> Title: C liL <br /> n = Phone:✓�^'l Time Out: 1f 40 Page f <br /> EHD 1624 (2m Pg) 4/3113 FOOD PROGRAM OF CONTINUATION <br />