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o QSAN JOAQUIN COUkv4 <br /> ar 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: o K Date: y _J'_ <br /> 13 <br /> Address: � I O e- 9d <br /> City: a C Zip Code: Clu <br /> Owner/Operator. j j Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> 8180 Posted L-I Yes L No Permit Posted 0 Yes C No Re-Inspection on or After: <br /> 6 n bwclee vc 3 -CO <br /> ue rn a v <br /> rc � rn q0W? 0bsorvrdl 01 NG_bnrl �U OOCr � <br /> anal l aho" 2 - doa, ) a 0 lace ri rN I ro0 /V <br /> C, 11 h a s h cF 1C fry z r. <br /> Item/Location ' r Itemnotaion Temperature <br /> Item/LocationBerri . at�ra� 1 l _ -. ;�$�11i:�:L=i;i�#ffR,l/li.. "::� ,:,:. ..�:...: .: <br /> r A 1 1 S L uGU V�O C y /" r1 ,? <br /> Sc.vs 5 a C 2 4"1 of l s3' - - 60r ( prep)elttie8#iUta 1 !t ttotaf!t : :. . . :,- iareyvast�lr <br /> Name: G Hand Sink: lOC 'F Chlorine: 100 PPM Heat: ,F <br /> Exp.Date: r f y arewashing Sink: 1 'F Quat.Amm.: ppm ther: 'IF <br /> Received By/Title: J k l <br /> EH Specialist: - _ Phone: <br /> •6 rt• 3/6� <br /> Time in: Time Out: Pagel of Z <br /> EHE 16x24 (2nd pg) 419112 F000 PROGRAM OIR CONTINUATION <br />