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a' ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 188 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> r.. -4- Telephone:(209)468-3420 Fax: (209)464-0138 Web:www,s gov.org/ehd <br /> k ' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> 't-��..- Date: 1,3 <br /> City: 5,�C4,(-- Zip Code: <br /> r Telephone: <br /> ddre <br /> OwnerlOperator: Y U y1 ,�. (may l� <br /> Pro ram Record: inspection Type: ri ` <br /> Program Element: r _0 g � L4.1 1. .} <br /> 6180 Posted tv Yes ❑ hermit Posted Yes ❑I Re Inspection on or After: <br /> flBERVATlONS <br /> A <br /> `At3d'COR} € TVI TIC3N5 � <br /> .,a p A ..a y.a;-. .,._ - :_#�,« ,.in. ai..w sy, d:y+Zn.- ! t. ZF.A: �° <br /> Iffi— <br /> ni— <br /> l rC40Y1 <br /> tenor <br /> rAv <br /> Yet -e r c. a s Lx-�r-e- 0 <br /> LCLA Y14- <br /> CC C <br /> Nil <br /> G% LA �- <br /> f <br /> LL <br /> r0 -� LOe <br /> ria:ts <br /> oil--!s --} -.,-4- nez CA 4-0 - <br /> p� <br /> r <br /> --PrD <br /> W <br /> UVarewashin <br /> e ,°' od.5a#rip Cer€iftcati on Fa �l►ty NutlTater,.7mt3erature ° � <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.bate: arewashi Sink: of Quat.Amm.: ppm Other: of <br /> Received By 1 T' e: , !?-eh <br /> EH Specialist: �u � 1 Phone: q'5 <br /> Time in: Time Out: i ! / Page of 1 <br /> EHO 16-24(2nd pg) 413113 F000 PROGRAM OR GONTINUATfON <br />