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��PQ •C�G SAN JOAQUIN COUI .' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s4gov.org/ehd <br /> �/FORD <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r ,j ,_ Date: <br /> r'1 --� .l, , n � - / J <br /> Address: 1L ' I I: City: TraZip Code: <br /> f r <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> 11.4 - (4 Ory { I00r.5 allS Un el e w ICan <br /> Ioe/aY . <br /> 0) Fac ; 1,' ► ,; C 41 re ) h oo64 iPMS ecl,� k {e <br /> 3 rr Wtl1 tNrr o �� W . 4h . Cc ~stco a.5 iA's : 1e. /Car <br /> 1 Who,. i U3 e. �pGarrrr f ;rnr✓JrdiJ <br /> So �a �; r0^ <br /> (�1 h ed p l r <br /> / i feriS <br /> r # -! kL' T /o or, 6 O rr-r C I- t' 1 <br /> re a/ On a , 5 ri 3 e r c It S o c,l <br /> 01 C Iconc0e CCn .1/a ;n r or re rngi v 1(,7 Ale <br /> 905 � r S Je �1 C/ 0S?r rS h 1 l� l; Un ; r1 <br /> ,i. <br /> Pro V. e/, in 2 l,)P r le S. <br /> 00\ 4, Cert. l; e Prou;A rece d <br /> Yl C1615 Or oa re onIt. -n WJ1 Occur <br /> y br,ILrn c, P r, b G 2 W Pc <br /> a r10cy rn US2 . dQTd✓ ted r; US� e d. <br /> MIEW <br /> s <br /> r C4 e (ly-ee 41,1S i-GP/Uc�� <br /> 3. a 32 <br /> Name: Hand Sink: IGUr 'F Chlorine: ppm Heat: aF <br /> Exp.Date: Warewashing Sink: L 'F Ouat.Amm.: ppm Other: eF <br /> Received By/Title: <br /> EH Specialist: Phone: ��/_ <br /> Time in: Time Out: / Page of <br /> EHD 16-24 (21`d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />