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I <br /> SAN JOAQUIN COUNTY <br /> `X ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y. 600 East Main Street, Stockton, CA 95202-3029 <br /> ��•. �,P Telephone: (209)468-3420 Fax. (209)464-0138 Web:www.sigov.orglehd <br /> �i FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: c mm — k 9 '12 Date: _ _ 9 <br /> ddress: ` m �1 Zip Code: <br /> Owner[Operator: Telephone: <br /> (a [D <br /> Program Element: Program Record: Ins ecY n T pe: <br /> i <br /> LLOLPosted ❑Yes D No Permit Posted ❑Yes ❑ No Re-Inspection on oe After: <br /> C_ -1,-a <br /> E <br /> '[ t <s nd <br /> r <br /> E q 4. l^ <br /> I � <br /> nk. � ,. 0 r 'r •qP � .y 'p' � F1 �iio.a� tlt� ''. 1�{i IITpOr�ti3r�,,n.` ' F.{,r"1q 3. f " 7' <br /> tt@'rrl ��_. rteR11p@1rdtUt� <br /> Safety CerfiCation ,i, .�.4, Fat HOt`Water,tperatui� <,, ? ,4 VYareMraslun <br /> Name:y Hand Sink: eFChlorine: ppm Heat of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> 11 <br /> Received By Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> LID <br /> EHD 16-23 (214 pg) 11106!08 FOOD 01R CONT%UATION <br /> _h <br />