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ot4A4'"• F u SAN JOAQUIN COUR._1 <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 /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r. I C q i c 2 +q�;�,,;n Date: <br /> Address: - 72LV I 5 .✓ C"' I rL( zip Code: C1S jb <br /> Owner/Operator: / Telephone: <br /> Program Element: Program Record: Inspection Type: Oc 0 1;n G <br /> B180 Posted L Yes No Permit Posted Yes F1 No Re-Inspection on or Atter: /� <br /> ood Ci I to B cr <br /> ! if r. 1 ir, et <br /> o n .n On au15:0/t 0 � (c1a111 ;� <br /> id-ug lean 4cdo <br /> 30 W P 0 0 5 4orr 0 bCV1' rc ulP. Sdc e rou/ <br /> t I o r _ lo- eo I r: - over J IGcp*,F <br /> C <br /> Tr + p U 1, q C1 r, V r o du r j <br /> VIA () ro r G Gn <br /> i c, i 5 04 n ; r A J leS2, 'hc, <br /> c RV t' 4:C,A 21 Q; 1) i� IIIU <br /> c./ C h /c,; <br /> Xlr I re rr e rgi lr rs r onn 4 # q- q6 F. 77)c,77)c, nl <br /> A d r 0.11104 n be ul G/ l F. ecl i I Weele <br /> G <br /> NO le ! U ✓ 0 ble r, C Ap c IL d S I Cr w - f. 'f✓. <br /> TruC �2-e6Gr• ' � I F <br /> l-GPGGh �fetf 'Iftr (- 6� rjl�L <br /> 'I0 I ld _ /_ <br /> L)e 540i '3 1 - 'cI1,dn +o j r ✓ Lori <br /> 3- door ( ri +wI on 94 r` y- door- 130r' <br /> 1Warewashing <br /> Name ,,.. + f . n ro ri o S and Sink: /OOb eF hlor e: t., ppm Heat: eF <br /> Exp. Date: 2- 3 -/S arewashing Sink: I yOl of uat.Amm.: Ppm Other: eF <br /> Received By I Title: <br /> EH Specialist: Phone: /�',3�6 f• <br /> Time in: I LG Time Out: i �Fly;l Page of <br /> EHD 1624 (2°pg) 4IN13 // FOOD PROGRAM OIR CONTINUATION <br />