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SAN JOAQUIN COUN,_,,i <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.s'aov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I / Date: <br /> Address: ly7s <br /> W, L^ S; City: -Tr-acZip Code: 1715,3 714 <br /> Owner/Operator: dr Telephone: 3 q Y. eSf. <br /> Program Element: Program Record: Inspection Type: PC aLA <br /> B180 Posted Yea ❑ No Permit Posted El Yes ❑No Re-Inspection on or After: R <br /> i —I 1s o1'ed o oc ro /s v <br /> + e low Qri Q rC' ✓✓1 00J r Cd C4C 45 <br /> Cary'ecl 4oday I/ <br /> a food h round CIN-ins. /nuo4 <br /> r o d �-J v 1 n c he,5 <br /> 3 ; Ve Jo red he 4u) een r 4C,bles Pervlou <br /> Y On d Sora i n / /e C /i erL colrecs <br /> 0 <br /> Sed So rve 'or,C, Ir, [ W n rnolit" i /G bi'm <br /> , le�e_ l / C' d4 <br /> oot a; r ryl U 6 e G if -rdaJ lip is <br /> A 4p 6n r f0c j a 4 <br /> L n flack o d Sp e /y <br /> TAn S4n :l �a irin i ns �/r•"I <br /> /�1 <br /> Q ioa � 0AA r' / P Co i r tc,< lo ss <br /> 1 n jef. <br /> dna 9 er 'S to u bS Ore 5,44bier roof <br /> ee N Droof <br /> a I k - ; ri �l l4and <br /> v r S F lra c , q6 r <br /> 4 yl ` -ame: Sink: of hlorine: ppm eat: °F <br /> xp.Date: ewashing Sink: 2 of uat.Amm.: PPM they: of <br /> eceived By/Title: <br /> H Specialist: Phone: <br /> ime in: o() Time Out: b Page of <br /> EHD 16-24 (2-Pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />