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SAN JOAQUIN COUN4Y <br /> XENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgay.orglehd <br /> �ZIFS `' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: cLt r✓ City: i r Zip Code: r � <br /> Owner/Operator: cLl Telephone: <br /> rmar ke 3 - /'7 C7 <br /> Program Element: Q Program cord: , O ! Inspection Type: { <br /> 8980 Posted Yes [7 No Permit Posted'71yes [7 No Re-Inspection on or After: <br /> 1 YY7 �iti te'O [s YYt. C.f11.1.✓l l C- (N 1 62-x.. !j(R,�t� <br /> k126 Jan J�-c 'Cy' ''6 i Lt 1'7 o Zd <br /> a4,-A 6U2 l 4_1 a� <br /> h ac to Lo <br /> M1 e nu-N',�4_Q -He d . <br /> it . t!) -d <br /> d o +or c �t,>•�Cwa,3 qLtl-eyu <br /> ,y) VY-Z-124 tt fr <br /> -la_ i <br /> * d46- -6 re-. 77 T�P__rj&Ajd 4e. wjq_s7 Ctak2ar Com'+ � <br /> -Y ,orat-ek v c �� fcec S towed • <br /> c <br /> ti v v - k b <br /> fflatv' cxa! S cLrr 3 u�'ul.a d.c u <br /> Ll <br /> 'r IIu-F;e•n : •�a,°, b�K �a ►�,t�- ' .� • Q• K S+r.�1L Co .ct} <br /> a 4t) (, K <br /> Nor (-�Y'}�_017-ROW <br /> [��]� yy q <br /> :il'•>.' ..;V:W -,y+` E L7 1 d z <br /> .,�ttltyc <br /> Name: H4ad Sin �of� ��� 'F Chlorine: ppm Heat: o f <br /> t G' <br /> Exp. Date: Warewashing Sink: of 0at.A �400ppm ther: of <br /> Received By 1 Title: <br /> EH Specialist: �. y C + Phone: <br /> Time in: 0:y Yom! Time Out: � . Pagelof � <br /> EHD 16-23 (2n°pg) 14/06108 FOOD 01R CONTINUATION <br />