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SAN JOAQUIN COUK.1 <br /> )�oEQ CA6 <br /> _ ? 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 /> ,CIFdh�' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> ddress: W y City: — Zip Code: /S j 7Z <br /> wner/Operator: Telephone: / <br /> Program Element: Program Record: Inspection Type: <br /> 8180 Posted - Yes No Permit Posted ❑Yes 0 NO Re-Inspection on or After: <br /> I Eel e) Man r l:�r) : (ale Ar, n <br /> Ger W: li ( If LI Z Wee KS 3c, FAn (a rectapfOf 0 n.ln rob <br /> K h a n d 5 ; n le Gn ras4rc 6aC. <br /> no ) 4ic n i 1I <br /> 3 W' oaQ h n Wer C a "/5 ra ;r C <br /> 0 pea vio1c. 4i Le rre r4 n Wee ,1 <br /> u <br /> 04ens ; l5 i h 'S Ue) b /0C le 40 d6 q <br /> N; Id- 14 4 <br /> Io <br /> 6 o a r 1° A : ., 1ra W W06 <br /> [. 2 We a 1s. f 10 pa, Y ; <br /> s ars C Cm e r 7 > <br /> CCA Irr, I to dri y <br /> // <br /> i C ' 0/e i n a [ : l : { ReM Cye o A9 <br /> qW eW 5 d re Jo ,eat' o <br /> (1�fi <br /> Tr / ( 2 - r e r 444 lel ,on <br /> PPo1 <br /> a. ccffe � 4c o <br /> 0n(� 0 en ba Woad on ahr o e, S -lore al 1 <br /> } O& J in 1 hl / Con 1u ;1 r. 4 Wu an <br /> Q 5 4 L O 16 or,, [ / e G 614, <br /> le ', ee Ch : ld ft ov r and r[ f el <br /> 1 rvt _ 1 ' <br /> ce r: L 'n 4o r- Tr U, 2 J11- IIF <br /> Food Safety Certification Facility Hot Water Temperature <br /> Name: _]�Hand Sink: <,F Chlorine: PPM Heat aF <br /> Exp.Date: _ Z)< r arewashing Sink: Z >F Ouat.Amm.: PPM Other: eF <br /> eceived By/Title: <br /> H Specialist: Phone: <br /> Y/I <br /> B <br /> !me In: �a -3s Time Out: Paget f z <br /> EHD 1624 (2^ pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />