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ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, <br /> Stockton, CA 95205-6232 <br /> Telephone: (209)468=3420 Fax: (209) 464-01,38 Web:wwwv�°.� <br /> 4 L;;�o•�a <br /> OOD PROGRAM OFFICIAL INSPECTION REPORT <br /> y <br /> F b � l <br /> Name of Facility: jjjG Zip Code: <br /> Ci <br /> ty: <br /> ddress'. Telephone: e-+-7�8_47Zj <br /> OwnerlOperator: `rte Cy- <br /> ILL r ylit pL � inspection Type: /7 <br /> ����C � Program Record: c��� -Z <br /> Program Element: Re-Inspection on or After: <br /> 6180 posted <br /> ❑Yes ❑ Rermit Posted ❑Yes ❑1 <br /> 77777�UgSER1l� 'If3�i$'A�l�`C RREG? <br /> lVE,AC JONS4 <br /> z <br /> money'-5 <br /> rn. <br /> L ra C e51 �'?Y ri'te�a. <br /> r l-}-? ' <br /> r - <br /> c�Pir1 L-k— -0 cle n cn G Q <br /> y.asr7 ' <br /> � _� � Terriperatuee •,. <br /> '� "� tte€nt ocahan � .f a - : <br /> . mpera <br /> ure. <br /> odd Safety Cei �cafao �s �N "Facii�ty lionafiet eri� erafurs •- <br /> }Y x e; <br /> Hand Sink: °F Chlorine: ppm Heat: °F <br /> Name: . <br /> ,F Quat.Amm.: ppm Other: OF <br /> Exp.©ate: arewashing Sink: <br /> Received By!Title: �'G <br /> Phone: Q� ,-� I• <br /> EH Specialist: � page of <br /> Tirne Out: 1 e,•� <br /> ime in: t <br /> /` FOOD PROGRAM OIR CONTINUATION <br /> EHD 16-24 (2°d pg) 4013 <br />