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�. �°"�" SAN JOAQUIN COUP <br /> ?lr' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.si4ov.orq/ehd <br /> �iFdRa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: "rc, - / Date: <br /> Address: 1 1 ) City: _/ Zip Code: J <br /> �ST 6 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> gt`c, <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> vn b1,,Clie I, YA <br /> nn <br /> 4-1 Coo ! eedS 4-u a Il rr ru ; - r l 5 r l2 <br /> IvyI 1u, 1). G 4 /� Grrtclr�. <br /> 3 n 1 ve W& AIF <br /> u 1 r, W. (h I,f) A r rY1 (10C r C,1 YV7 e re <br /> S G ; W Ct 4 e r r : r�5 G/ S n4 n,' '1 i t C � i ✓YI e 6/. � <br /> Irue ()_- ii ) cu br e <br /> P J <br /> 0 5 'I /< U n /cL C k3 Led <br /> t, yl <br /> I Y , i q Ill PS 7rC ,,►') <br /> ! r, e/71 l -7—A <br /> ct cJ <br /> LA Ao o t he Tc 111 i r, re ir: v t,, N 4a <br /> 2 In Cie r ^ / � •� Garr �U l/ Sub <br /> 3 �CrC• d Ur ccc <br /> re(c� -1 G CIG <br /> } f C,i 4 'S4 prn G boy r4ONG3. Store �ar 1 . lltij eft.1cI <br /> r U I r Cf rip r <br /> I� , C <br /> 13 I' ruC cc.- ( rr , Yl /t— <br /> rn� �Z r,� � � G aIX <br /> 3 bct y/ <br /> Name: 'lCn Hand Sink: /U <br /> OF Chlorine: ppm HeaY:� 7 /a�_ OF <br /> Exp.Date: / arewashing Sink: J� OF Ouat.Amm.: ppm Other: OF <br /> Received By/Title- <br /> EH Specialist: -� Phone: <br /> Time in: Time Out: �f Page_ of <br /> EHD 16-24 (2nd pg) 4/3/13 I FOOD PROGRAM OIR CONTINUATION <br />