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"Rx'N• .1.1 SAN JOAQUIN COUN, 1 <br /> r a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> ame of Facility: <br /> N Z Z J u On,", ,, + Date: -� <br /> Address: 4b (ti) City: Zip Cod%C S.Y Irc, r e: <br /> wner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> Cu l,n( <br /> 8180 Posted C Yes ❑ No Permit Posted Vas ❑No Reinspection on or After: <br /> l IhoW .n C kfn a ; ro,m 4r jw fe r a r 4 <br /> 01� S,A a .s to f u i y c E . hi a <br /> rQ �r: r C, Jbt 10 ") Lill'r ct <br /> y. Id 'u On 1 �c 41 N n a{r r l v m <br /> a n d n 113 <br /> 4 p a r i n C le A ds n <br /> d h` n n zor It J +cro <br /> faI n ! { in Scnil; l bi; ( k .r. ( { J r10 <br /> C 5 5 fornd c, b cv, u l.; Gcrreraed. <br /> tOr lSn - � 4 �� r ✓ f E 'C I * c' rAGn - �� <br /> cS QZr1: <br /> / t Turbe r Nl I' <br /> Faod Safety Certification Facility Hot Water Temperature <br /> Name Hand Sink: `F Chlorine: `l PPM eat: op <br /> Exp.Date: (1 ) S arewashing Sink: -F Oust.Amm.: J PPM <br /> Other: oP <br /> Received By/Title: <br /> EH Specialist: _ Phone: U <br /> !me in: a: y 2 Time Out: ,.31 0 Pag,of 2 <br /> EHD 16-24 (2^ pg)4013 FOOD PROGRAM OIR CONTINUATION <br />