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SAN JOAQUIN COUNTY <br /> Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • . , Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s0gov.org/ehd <br /> Li FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 7jF\0JUm 1 ''1 Date: l <br /> ddress: 2,qDr V, %VIAC) City: Zip Code: <br /> Owner/Operator: S / Telephone: tJ10�� <br /> Program Element: Prroram Record: 1' 6 Inspection Type: <br /> SB180 Posted Yes ❑ o Permit Posted ❑Yes 19446 Re-Inspection on or After: 0---k11 <br /> QBSERVATIONS AND,&JRRECTIVE ACTION <br /> p h w zf i <br /> D► ' <br /> q SGN1:� Tpcd CcMfWS 07) 't <br /> car <br /> �v NU s <br /> All WC* `S � _kCkC IWCkq - <br /> ��'CM6W_ w FMA WOMincA 06-4-sq)NCQS <br /> OSS <br /> - S cm SI <br /> O0Wv S 01D C'44C <br /> Cin s <br /> �i. <br /> pod Safety Certificatioi; <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Pag, of <br /> EHD 16-24 (211 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />