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p.°"`" SAN JOAQUIN COUNTY <br /> ° ........ C <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q., ��P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> ClFOFt <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: S + e) Date: <br /> Address: 8 43 , . 1 -t r{"140 + ��• City. S+0 +0n Zip Code: 01!5-.7-03 <br /> Owner/Operator: c�-� T e, -V IOn-&(d Telephone: 44cao _ 14-73 <br /> Program Element: Zy Prog m Record: P RO t bO39-7 Inspection Type: <br /> SB180 Poste Yes ❑ No Permit Posted Yes ❑ No Re-Inspection on or After: <br /> r v� Gvv _ d,e.� no Let Ir o ne s <br /> rl UO P, h � it�C1 n 1->L.i rCAD 0 te-r <br /> Rt rrza v-e - u s -� <br /> cc' G <br /> y0A yLe r7 c YA kzA-L <br /> —� '1 q_/ - <br /> 1 M'GZ.C9 G7 p�Q >"' r riz,o rs•�-�—�T <br /> jo <br /> -e C <br /> �c I� O n aL r �r rno rrLe- +k t- <br /> 6 <br /> S a <br /> x'1076.• qve Otc�n�¢r C��-e (.L�.�- ,-m�c�'=r1r� <br /> ITO <br /> or ! <br /> Name: Hand Sink: of rw <br /> n D ppm Heat: 'F <br /> Exp.Dat are ashing Sink: 'F Quat.Amm.: ppm Other: `F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> J . <br /> EHD 16-24 (2^a pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />