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SAN JOAQUIN COU1-4 <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4clada p Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siciov.org/ehd <br /> yP y- 2ss I <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: rA S 11 C T rA we t /4 l q Date: 16 _3_/3 <br /> Address: I a a 2 L e o n b; City' R ; o n Zip Code: 919 J6,c <br /> Owner/Operator: Telephone: Sy ,Z/1 <br /> .=A 4i, if, S: n <br /> Program Element: Ib 02 Program Record: S O0 Inspection Type: Cc A /% <br /> v <br /> rl <br /> B18-Posted Yes No Permit Posted Yes - No Re-Inspection on or After: <br /> A 1 - in hrt�.S 1 IOo/' :n;S hr� AnCC rP 14 . e <br /> 4 hin �mCkA ) cove ). ccrrec# in I rvlP» 1rt <br /> WP P! fuA M a # 1/ 7 'F, 7"4 h44 <br /> OY v 2G ' Gcrr c � . n 1 Week. <br /> (Will nod be USr„ 6c% ;s Pn ser <br /> y a U J r O i A ; �tJ i /� Well G 40'. <br /> 615 2a3 <br /> 0' YO r11y � n rr a hu Ile <br /> Wal <br /> " tion Feci1 - ater Temperature Warewashing ; <br /> ame: Hand Sink: ,.F Chlorine: PPm Heat: F <br /> Exp.Date: Sink: / /Jo of Ouat.Amm.: ppm ther: - of <br /> Received By/Title: 'ti V4.g)L <br /> EH Specialist: Phone: <br /> !me in: Time Out: .y0 t 1 Page of <br /> z: <br /> EHD 16-24 (2n°Pg)4/313 FOOD PROGRAM OIR CONTINUATION <br />