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SAN JOAQUIN COUNTY <br /> ya•�.�ati <br /> w ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.si ov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 6,1 !J? - Date: <br /> ddress: 1 D 7 14 � YL K�j City: C Zip Code: '216 <br /> Owner/Operator: - Telephone: <br /> l-QX15 dCA- Q-7 <br /> Program Element: + (-) Program Record: .� C� Inspection Type: <br /> rB180 Posted qYes. ❑ No Permit Posted Yes ❑ No Re-Inspection on or After: <br /> �7lklRM1I_� r7'•!'V7��IQY. imf <br /> -t,;. d La c.,r s n <br /> 1 i7 <br /> Y�E I[11CZ rl�'^► -- - ?iY (�S i 5-P Y'L/4- ay--e Ck.._. --i--D Y— L _0 C-1._ rn <br /> 1- <br /> C67c-r•1-�e.Y <br /> ,% ?w: j r r �:_- ��. ✓, moi-` j s� r': <br /> �.0 }fi � �Itetin,�•L.ptation �:: fiempe�ts�r,�e: <br /> _ �,,s =Food-Saifetji Certification r '`�tri ` #,Faciiity.t'ijot:Water�3eti7peraq�e ,; ,�` ��~ ��;�;,�:�'' teras <br /> Name: Hand Sink: of Chlorine: ppm Heat 'F <br /> Exp.Date: Warewashing Sink: `F uat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: 1 � rJ� Phone: <br /> Time in: X10-*a�D L c� Time Out: S Page of <br /> EHD 16-23 (2n°pcl) 11166!08 FOOD OR CONTINUATION <br />