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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 46$-3420 Fax: (209) 464-0138 Web:vrww.si4ov.orglehd t <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: S Date:-1-21-- 16 <br /> Address: aq ria c, City: -f`p� Zip Code: <br /> Owner/Operator: 1 r U I I. LL( <br /> r Telephone: <br /> � Gr <br /> Program Element: 117 1 / O Program Record: c Oci 0 ! Inspection Type: <br /> Lnoposted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: <br /> yL'y., yai;��yy� {(,w�¢% (m � . {.y� ]qyYy�1p� <br /> ' M AYJ'. /. .>., ✓„ i1 A8! �� R.0 99A �W ll']�11I�'d JIM <br /> Com " ! in h II\' 4ChPn is b.-V )(ev, 4e r ;$ <br /> -, n <br /> 011d crA 4s e rn piovto s 46 1 <br /> J d - GC S ✓ i �pry 4, Ie <br /> n Li t� 1 1 -cIcdr. 1+a5 M'.`S S. n c� ;S ►()dS h4' !. <br /> 1;�• GS SOf-tPcne. SC �+e c�y� -jG 6,rlo V Oa <br /> j6re rd, <br /> h b; S r C � � ' � S r ldor <br /> ?'Y1On h r` <br /> cof)j"Cl e i h A4L, O <br /> r .r <br /> 1 <br /> rame: Hand Sink: of Chlorine: ppm Heat: -F <br /> Warewashing Sink: of Quat.Amm.: ppm Other: 'F <br /> Received By 1 T e 4 C <br /> EH Specialist: - Phone: �,U? 614- <br />'f ime in: 10 <br /> 0 1 04 <br /> Time Out: i f U Page 10 <br /> f/ <br /> EHD 16-24 (211 pg) 413113 V FOOD PROGRAM OIR CONTINUATION <br /> 5 <br />