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SAN JOAQUIN COU Y <br /> p .. <br /> �O- .COG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> 4�/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT 3-5/5 <br /> Name of Facility: �'� Date: Z��e <br /> Address: / INFO ) City: C4C Zip Code: �9-=�t2�r�� <br /> Owner/Operator: � 5 C1/1,,,t / ei� Telephone: y _ D o <br /> Program Element: Pr gram Record:(�lJ,r�R 5 .77 Inspection Type:a n d �7hn� <br /> B180 Posted Yes ❑ Rermit Posted !' ''C 4Yes ❑ I Re-Inspection on or After: <br /> T3 ¢Y <br /> I4• _ S.�n *� Z <br /> y <br /> C 3 ro <br /> R.. 3 <br /> a a� �h-oo n e.tic_ d- TIez, �-O I L-t - <br /> l-G,, n d s o CC Pro -1 ck- ct - of a- s 1 <br /> cY U� L.4 YL-0- I&4,t-s 5Y)�-e 2.e— U-M r k- a -OL";U r ` lee_ <br /> M_P_r n u.') 1 L' (-.Q- l -e -moo d �o vie r d i o <br /> O i rl ,e -moo rm han J c oa-s k i 5 I 5, (o 115 <br /> 69 Q -4 _6'orgo &I n of 0+ r rr� +f —01 1', s C-i {-e-- <br /> L,o Y•e-s kYvQ m l use lL 5 u!a y", w C,_ e <br /> r: <br /> K5+%:,Y7 h.0+ 5 h 61 t b1 e I vU'F o Y- <br /> 01 <br /> b POS 4' i,.A a Y--P Lo�).QR— Y S 4 Yoo rri YIm ct I., a <br /> (Q rj PGZ C:f -F► LAU <br /> --- 41)C4 L+tsn Q 5 2A•7 <br /> Item/Location pture Item I <br /> sco✓ <br /> 64_/Ofy'7 '- 6C-VAr) . l�{l` C,KeScav U),2rr L •-� '��200� <br /> !� cc r r► o D o fczfn � l alb <br /> `3 L4,e Air q0 <br /> b. Warewashing <br /> Name: Meci�� �1 Hd S'nk. /� of Chlorine ppm Heat: of <br /> Exp. Date: �� "� sliirSin / of i at.Amm.:�{► ppm Other: of <br /> r� I` <br /> Received By/Titl v <br /> EH Specialist: \ f n Phone: <br /> Y.LtJC, I.wj�l�cs. <br /> Time in: Time Out: <br /> LZ, ® Page,�f <br /> EHD 16-24 (2otl pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />