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aPg41fl, o SAN JOAQUIN COUN,4 <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: b 5 Q To h A X i ryl S h o-4 <br /> Date: y 1S- <br /> ddress: 3J 2GU ( 'v r u City: Zip Code: 95j;, 7 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: 2 AAf <br /> SBIBO Posted Yes No Permit Posted - Yes No Re-Inspection on or After: <br /> S AND CO; <br /> i L- h 4 Gr r e,pn" <br /> e (, ne :w t <br /> Su n;Ji C04,$ � uu/ I _ � 1 <br /> V1 1 r 7 n (3-410 Or I ) rut CfAi )K — l/r r W4 he-;A. W' <br /> Tr QIA I SPA C 2" •or 7-rke ; I �7 r <br /> Tru 3 rF W cArrno, / 57 <br /> r P r 1 S'Yl' td ar/rl f r- MClf <br /> Food Safety Certification Facility Hot Water Temperate _,; Gam <br /> _ ; Warewashing <br /> Name. 7� Hand Sink: ,.F Chlorine: PPM Heat: of <br /> Exp.Date: � I,_I � arewashing Sink: � .p Oua[. Amm.: PPM Other. eF <br /> Received By/Title <br /> EH Specialist: _ Phone: 316 y <br /> ime in: Time Out: 40.J0 <br /> Pagel of z <br /> EHD 1624(20 pg) 4rN13 FOOD PROGRAM OR CONTINUATION <br />