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SAN JOAQUIN COUNTI-'` <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> . ... y ;Q• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s'qov.org/ehd <br /> gci0bVO <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ir f 1_ � Date: _ _ I <br /> Address: 13 J� City:��` Zip Code: �L <br /> Owner/Operator: Q !ZJ Telephone: <br /> Program Element: t& � Program Record: / Inspection Type: : <br /> 58180 Posted C]Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> TIOt�S �l[� �REGt11EACTIONS �A <br /> .m <br /> -- / <br /> C7 G) �mn4 -t � ln � <br /> c�2� r�Ge. !� er• ��z-c- .� a. c I •.�t` ccs �— <br /> 6�0 C3 <br /> Vo fir' O hey o -le,1 47 <br /> ff'-t h�rzc <br /> [22 ,iI e eW GL. nLY <br /> pr/i r / r- �-i 6c x ci, O < !7.O <br /> 3 <br /> SQ r U. 67Y-em Y-e 13,04: r �r ` <br /> If <br /> � ttza, <br /> � <br /> J na'jci - mperature tem'la�o em icire- tl:oraon. e r e; <br /> �� aRaP : <br /> v ,rtr 5y eir �ca ria E3t11[2r't per` tnre � 4ia[e�£ashin , <br /> Name: Hand Sink: of Chlorine: ppm Heat: eF <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> i <br /> ime in: G,a,f Time Out: f; Paged of <br /> EHD 16.24 (2m pg) 1112/D9 1 FOOD PROGRAM OIR CONTINUATION <br />