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SAN JOAQUIN COU& <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c'... �P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s'gov.org/ehd <br /> '9L/F'ORtN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� r Date: 1 <br /> Address: n Cit Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes -I No Permit Posted Yes F- No Re-Inspection on or After: <br /> SAND_ <br /> .. ERVATI{ NS D C0 3 _ <br /> ..� - �rtcr✓t GC S q u �� 5P� IT <br /> C/o�. n C%✓ <br /> 11 'ja I'sf h9 S 1c, Ir j- S Gl n <br /> Ccrr oc 1. <br /> L� t Gf ` � v1 oV Ir 1'n3;C/ <br /> .c ile3L,,, Id"W P 0 /) ht loc-r I n cr K -; r%. it,C.I CA, <br /> floor t A'5 r Pea Ict(C ro)ee'l 41l115 >'cdcl <br /> to ci &r,5 - re j ['ar <br /> Te - i ns c l , Crn W, 11 CCA r <br /> u <br /> ltem/Location ";Temperature <br /> - i <br /> rA <br /> r-oo� afety'Cert�� �` <br /> Name: SHano-Sink: of 7Chlorine7: ."!Heat: OF <br /> Exp.Date: „ Warewashing Sink: OF m: ppm Other: of <br /> Received By/Title: ` <br /> EH Specialist: v Phone: y- <br /> Time in: p C5 Time Out: I Page of <br /> i <br /> EHD 16-24 (2°d Pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />