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SAN JOAQUIN COUNT! <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1865 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)465-3420 Fax: (209) 464-0138 Web:www.smqov.orglehd <br /> •9CIF0�� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: P r , f i �y rCy <br /> Date: b �20 <br /> ddress: h S City: Tr Zip Code: <br /> wnerlOperator: Telephone: <br /> GCrra.� <br /> Program Element: 16 2 Program Record: Eo 5.2 Inspection Type: A !; <br /> 8180 Posted ❑Yes ❑ Rermit Posted C Yes ❑I Re-Inspection on or After:WE <br /> f <br /> t e A ON$ <br /> IC P r o it rc 14'r C•1 j r, n5 O � ������r/. CCl rPt� ac'�Gs V <br /> p <br /> s 11 G7 ; <br /> 1 r 1 l* iLh <br /> Z a Wu U +'G �Grr✓!7 <br /> .Ll' 3 j <br /> POMP a -J c <br /> -' T <br /> I' <br /> rl'1CA"i U�+ ��•C S/c��nf� rCr�r�cfr - <br /> ttar 0F� Temperature' Ito.qt# atlbzlt ernper titre <br /> F €t ety eitii Ca is 1� acaiEty ot.water'Temooraturo, Watelaas?timg <br /> Name: Hand Sink: o fChlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm ther: of <br /> Received By l Title: <br /> EH Specialist: - Phone: / y <br /> ime in: C Time Out: / Page of•2 <br /> EHD 16-24 (2n1 pg) 41303 J ! FOOD PROGRAM CIR CONTINUATION <br />