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SAN JOAQUIN COUI ' <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.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: O Q r105 Ma LQ I'0 mt rj I I Date: a <br /> ddress: Zi <br /> 5 as a G fn'L /Nj -e- City: <br /> 'fon p Code: 95 2o7 <br /> Owner/Operator: �lr1-e 5 t 41-0n G Telephone: <br /> Program Element: I(O 0 p Pr ram Record: 0-000 '39 1 4 O Inspection Type: /�_ La.n4 <br /> 8180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: W <br /> tTU�S <br /> I)Lr Of 2 alb `I"ku2 ort 1/ 17/15 q n.d 1/1 S �,5 G o IlC oC4 ' <br /> ko rri I Gt.tC1i-+r � o K `F -t� a-1-0 vxx- a c — -b dorm r-ooryj <br /> L.VN 6oi ri _[) 1-e o . (, Irl e r1 �5 P;-t w-n+ +v -.e ar-f .-,-1 <br /> A.-Cj C 1,rtsnD b r 4!_c_-1- L- , -fnaoC� <br /> o Tu S-tvre MR LAJ k.0 LA)a<s CAW A r-2 �S <br /> ''1'+ He- 6 4r,.4c-o4 Gum+nr--.e I- S eLt J f <br /> r►N1.21�.Q W a s -yS cl 4V r h 4-c✓ C� b0in Ie O <br /> �OC3 W 55 �J IS via-S l.�L_�h f:�'N c%l e o rnze_.3 room <br /> f <br /> W "t.'v_ a- Gc w c_e__ ea tea( P a 'S 7-Z? <br /> r c: d-r 4- -- <br /> �5 _ ho u�Or ,-, GG o d c.s )& •4 o� �=c.� hath <br /> a ' o of n o.4- CO Ld -e r7 dk ,Sh a d L <br /> r Q Ser✓/, -�i 67'7 5 "e)6e ✓' an_, 1W <br /> ave CLX a n - /Lob <br /> _71—Z-5h% <br /> Warewash!pg <br /> �,.:.. <br /> Name: Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: POO ppm ther: of <br /> Received By/Title: <br /> EH Specialist: Phone: �� f <br /> Time in: • •if Time Out: Pag of <br /> EHD 16-24 (21°pg) 4,'3,113 FOOD PROGRAM OR CONTINUATION <br />