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SAN JOAQUIN COUM,�i( <br /> ° '.aG <br /> 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: 5 �, 4r /1'�!a y �- ,��wn Ti�Date: ZO-1 S <br /> Address: 1S t`— 54 City: Zip Code: <br /> flL- <br /> wnerlOperator: Telephone: <br /> Program Element: Program Record: Inspection Type: - <br /> -180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: <br /> � 5 VATION,AND,CliREGT <br /> LA YM <br /> F c4 J; c <br /> n y _ PA I M S rj 1 r .l - <br /> / jr;r'� tlirl <br /> 46 <br /> � I Ut C4 ; fin ) <br /> � CCht � � ; J uC <br /> T r► ratu aerO .0coui ti; 73etn , raga <br /> i et ° Li1fr ati�e> t* dtt yVate mpe a� -we tin9 <br /> Name: Hand Sink: F hlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: of eat.Amm.: ppm ther: of <br /> Received By/Title Y_ fy _ <br /> EH Specialist:." r Phone: <br /> Time in: Time Out: Page <br /> f <br /> EHD 1624 (211'pg) 413113 FOOD PROGRAM OR CONTINJATION <br />