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SAN JOAQUIN COV'--rY <br /> XENVIRONMENTAL HEALTH ( ARTMENT <br /> 1 868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c¢�fi�ss�N�� Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:wwwsiaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 147 / l Date: 7,12411 <br /> Address: t� City: Zip Code: <br /> Owner/Operator: -ta-✓� fjyi Telephone: <br /> Program Element:` /r Program Record: /,� (kfq Inspection Type: <br /> B180 Posted les .: No Permit Posted Yes No Re-inspection on or After: <br /> pie ERr s rro NO <br /> ✓ _ <br /> 4��M�411 <br /> IV <br /> ItetNloeij IQn TempeTature Mem11ocation Temperature <br /> U 7' diZ <br /> Food Sa#fYy Certaficafictn: Facifity ffat Wates ern er tuae, terva5liing <br /> Name: Hand Sink: aF 5G-In; ppm Heat: `F <br /> Exp.Date: Warewashing Sink: `F Quat.Amm.: ppm r <br /> ther: of <br /> Received By I Tit! . <br /> EH Specialist: Phone: <br /> ime in: r Time Out: V Page of <br /> EHO 16-24 (2-Pg) 413113 V FOOD PROGRAM 01R CONTINUATION <br />