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SAN JOAQUIN COUNTY <br /> a ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 9868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s ov.or lehd <br /> IE FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> � <br /> Name of Facility: a in A r b 5 6 r.• I I Date: <br /> CC- <br /> Address: 5'4 9 C/V r <br /> r .1 City: Tr CA C_NZip Code: <br /> W <br /> Ownerloperator: W Telephone: <br /> Program Element: Program Record: Inspection Type: CI U <br /> l <br />� 8180 Posted ©Yes ❑ Rermit Posted o Yes ❑ I Re-Inspection on or After: <br /> i <br /> ............. :.........::;:::::;.,fie <br /> A <br /> Y i <br /> - ,.,.... ,. a.: ,........ e, ,...... 0 <br /> f # ✓ ( V ✓F re, 0 ✓� <br /> S � ; C K aSe lS <br /> S n ; }iz r }'JU c e 0k le P r ; 6)- aG <br /> 1' it C 1l � 0yl P <br /> Q , of an L4d u115 ; f ; r• <br /> Vi C IG 4 .4Gr . <br /> 4 .. . 1 -w orN e u �n 4• 1on , <br /> ST.c 5 ; tMAC 11r, Sccy <br /> 1a n -hod ti <br /> nS /A &r& 01 <br /> - A hA 14 re <br /> err, S: Js ; n C e I A U �0r esd <br /> rPr- jr ' <br /> Or. G re C 40 d4 t , <br /> 1 A _� � RemVe o, bSorben � <br /> 0 i Y}+CA;Y� UG Cir��l(Jr [Gr T1s G Uu, r✓G illi. - <br /> Zer I�fj C)O v /or i �. <br /> a l► I U c G <br /> dku <br /> r y / y iCe 66 a <br /> a. d - Tri, X111' <br /> Name: d fir. r) Hand Sink: of Chlorine: ppm Heat: 'F <br /> Exp.Date: r arewashing Sink: 'F Quat.Amm.: ppm Other: "F <br /> Received By!Title: <br /> EH Specialist: Phone: r,,.746 <br /> JK <br /> ime in: Time Out: 2 Page of 2 <br /> EHD 16-24(2O pg) 413113 FOOD PROGRAM OIR CONTINUATION <br /> tl <br />