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A <br /> SAN JOAOU[N COUNT <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> e cQi1�o ;A.. Telephone:(209) 468-3420 Fax:(209)464-0138 Web:Www-sjgov_.or,/q ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: A I v t ❑ate' 4-/ (0 p <br /> Address: ` C City: C dip Coder <br /> Owner/Operator: G " Telephone — 71 <br /> Program Element: ao3q q Program Record: f ,cam Inspection Type: !� - <br /> SB189 Posted Yes No Permit Posted Yes {No Re-inspection on or After: <br /> QBSEFi1AT1QN5.3AN©CRF2C�1VE <br /> ,:'- � '-'s . _ :.'��+o_--.zxFy� ,x .,i. 4'- -''a-• ,. z. ...n l'' 'ciX...- f,'.F..r. <br /> cl- <br /> �^r VjCqk 44-- f&64S lam ice'. <br /> & ©- U <br /> o <br /> 1 co :ter <br /> P-t Ono <br /> • Iterrtil ocaiionr xw `_ ";, eniperature ti <br /> P.. l' ,ua� Ternpe�atura <br /> _- <br /> 7 V <br /> o > - <br /> _,-..--- .. � e.._a.,-s'-�-.w _.��a:�4_: <br /> - V1larevYastiing z -- <br /> ': Foni#oafs 6&rtificatidH?=' zx.,_ t aeilit iR WaterM emperature F __�- =w _ <br /> Name-J -- - Hand Sink: 'F Chlorine: ppm Heat: -F <br /> Exp.Dat . Warewashing Sink: of Quat.Amm.: ppm Other: -F <br /> Received By!Till <br /> EH Specialist: \ Phone: <br /> ime in: am <br /> Time Out: Page of <br /> EH©16-24 (2, pg) 413J13 FOOD PROGRAM OR CONTINUATION <br />