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�n�,a lMQ..rA SAN JOAQUIN COU,,.,VY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> *.. r'.... Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> CI FORK <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <nod- - Sc-lzo 0 1 Date: - <br /> ddress: -2 9?' ��W S W oo 8,-> ) V d city` 6+0 _Gf_y _p Zip Code: of -;L0 G <br /> wner/Operatioor: Mu - /yTelephone: c)3 _ 6-LO <br /> Program Element: 1 Program Record: Q Kd 5 O SSD 0 Inspection Type z04 <br /> � T ,h <br /> 8180 Posted Npes 0 No Permit Posted es 0 No Re-Inspection on or After:CD <br /> w <br /> �� <br /> 0 <br /> tcJ n o +r <br /> ►l�(,i <br /> 4o0(0 >/ (i D F <br /> h�- coo(0 229° bt�armri✓ 111177 <br /> t N(✓ � �iA° Trnvl �(` <br /> � A IV 11 O <br /> ion Facility Hot Water Te'� .;r: Warewash i <br /> am8; Gro rl ��1 L Hand Sink: I'�� �F C rine: m Heat =F <br /> CC l ?fly PP <br /> Exp.Date: J Ware ashin Sink: 14r)`F rust.Amm.: PPM <br /> ther: 'F <br /> Received By/Title: <br /> EH Specialist: ! Phone: 9 53 _ -231 7 <br /> Timein: 10—q6 C�'� Time Out: 11"C) 6 <br /> Paget <br /> EHD 1624 (2-Pg) 4I 13 FOOD PROGRAM OUR CONTINUATION <br />