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�gqurN c� SAN',JOAOUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> --_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-34201 Fax.(209) 464-0138 Web:www.sffigov.or_q/ehd <br /> 4Ll�aR <br /> { <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility. r N Date: <br /> Address: v rt City: Zip Code: IF <br /> Owner/Operator. tm /� j� /� Telephone: (R- <br /> Program <br /> n T <br /> Program Element: /„� Program Rec d: 3�j Inspection Type: <br /> (X [Y lGl Ali! <br /> 8180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> F�l <br /> °e x ' f 3 C�BSR�A ON�A � [} .�T� � W[7 _ <br /> ... .,..,. .. ......... e �<:. <br /> ........,._. .nv.,.5. .fl..._., -.ani:... .................. . .<... _... �..... ....moi <br /> p <br /> L <br /> I <br /> �Yt <br /> Q/ em a <br /> r Ir <br /> r <br /> i <br /> i <br /> `` x <br /> �k <br /> . ly <br /> r Y <br /> II i <br /> �k <br /> �i <br /> I� <br /> 0 <br /> .� �.,, :�,^ `g'fternll.o �t�ts� m..............;� 'i`em�eretirr�;,,. ..,_ >• °�#;erri�I�ncatiorY 7err� atii�'e i <br /> it <br /> i <br /> fuoti Safefy Cd #jC�#�o�ii � ' " :< . ;Facifrty 1�fat 111Y°aterP7erx1 er�#ttr'�, . <br /> -,"W"?? .........�111farewaslung, . <br /> Name: Hand Sink: it of Chlorine: ppm Heat: I-F <br /> Exp.Date: arewashing Sink: aF Ouat.Amm.: ppm Other: <br /> Received By/Title: ,Y <br /> EH Specialist: Phone:Dt- <br /> p� <br /> G r a <br /> ime in: � .� Time Out: Page of <br /> /) r c <br /> FHD 16-24 (21"pg) 413113 FOOD PROGRAM OR CONTINUATION' <br /> i <br /> IIf <br />