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SAN JOAQUIN COUNTY <br /> z ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.si,ov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L <br /> Date: 4 <br /> Address: 1111SO J r S h h City: —T—r <br /> n r TOS1(1 C Zip Code: C?S S 7 <br /> Owner/Operator: 1 Telephone: / <br /> Program Element: ! Q Cj Program Record: COO <br /> v G I q j�Gj Inspection Type: <br /> lel [Grp <br /> B180 Posted ❑Yes E Permit Posted D Yes rl t Re-Inspection on or After: <br /> ---S � J1.5 • FGC , �,� � � 0.3 ✓Yli(f COCKroc_��l Tr <br /> o C r at, h >� oc,r,f <br /> f af()j e (d n I - a c k a bje r ke d C; I f <br /> hos h e S 4- r i 6 -C 1; r> .-c- 4- <br /> v <br /> Co J <br /> ocatrn 1 �: 111ics>► Temperature <br /> Food. trci � 1^s�ic�t.�� atsr 1'eet�,ete 4Narer�ras�ttrE <br /> Name: Hand Sink: 'F hlorine: ppm Heat: "F <br /> Exp.Date: ivamwashing Sink: 'F Quat.Amm.: ppm ther: of <br /> Received By!Title: <br /> EH Specialist: FPhone: <br /> Time in: Time Out: Page of <br /> 1 a. � I <br /> FHD 16-24 (2'"pg) 413!13 FOOD PROGRAM OIR CONTINUATION <br /> S <br />