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SAN JOAQUIN COUN) <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _. 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 46$-3420 Fax: (209)464-0138 Web:www.sigov.orgIehd <br /> 4t1aaN: <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date:4-&).O? <br /> Address: r1 Sr City. Zip Code: C1 <br /> 53 7 <br /> J , <br /> Owner/Operator: 1111tH G � Telephone: x32- 93?Z <br /> Program Element: fGGA 'Program Record:�oo0 3G VO 2 Inspection Type:Q �T <br /> VB180 Posted Xes O No Permit Posted Yes [] No Re-Inspection on or After: <br /> d6d" A*i4.j?- :57;47o?-LS <br /> A&AN Ove 2 w 57DRei] R657'/?za <br /> OR PPE r Ls Cc� Ruin's <br /> f3irrgRm1"-5 AA< 01.E u1 e44tftr r-> R?61'CPU- S c4ppAt b <br /> �uTS r L Txr S �y2F R afv�9<, 1A 'NOT' $R1 Aj& 1/U @ t i,1 <br /> �- �` Is Glonf }¢ THIS SIV UESTI G+4T�cLi1 r <br /> �`..... , , ,flcatlan; aclity'. otNaEex La ► raEur areai ' tt�g: <br /> Name: Hand Sink: OF Chlorine: ppm Heat: OF <br /> Exp.Date: Warewashing Sink: OF Quat.Amm.: ppm then. OF <br /> Received By 1 Title: x 44 <br /> ` <br /> EH Specialist: Phone: r^ <br /> ime in: Time Out: 7 Page of <br /> EHD 16-23 (2^ pg) 11106!08 •G FOOD OIR CONTINUATION <br />