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PQu�k SAN JOAQUIN COUN'' <br /> N: :t <br /> ENVIRONMENTAL HEALTH DErARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..• �;;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.orq/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 6 '� d�1 if --, Date: r���I j <br /> Address: U `i�J S �1�,�, /Z� City: S#&\—r-U Zip Code: �2 I <br /> Owner/Operator: �i G1 T� �� `, , 1 Telephone: _ �� <br /> Program Element:_ 1�2 I Pro am Record: 65 L Inspection Type: p n rl <br /> SB180 Posted Yes No Permit Posted es No Re-Inspection on or After: <br /> W MM <br /> �- <br /> s t U°r oncl wmeN tin <br /> C� �o 1-f M 1c,, ee S � f(30 <br /> S� 4-0cAj tt 131�"- CX- <br /> offQ <br /> h� <br /> e Qtwe n S 0 y care <br /> Cr <br /> o � �M � C N\&&, coq .s M - cum s�n <br /> w i ��o Cr S - � 0, ��� Can <br /> h Srn 01)d brtpe <br /> #NtV72s . rcKTecue - <br /> r-e^r�wts ve t c viiAckn C <br /> 1 <br /> .T ' <br /> 1 tr t . <br /> ter.: <br /> o •,. z r <br /> Name: ]r i Hand Sink: U 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: C� 2Z Warewashing Sink: l– <br /> I� G� of Cluat.Amm.: V- I ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: n <br /> Time in: �• ; 1 Time Out: '1,;- 0 PageZof <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />