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?WN..0 SAN JOAQUIN COUF <br /> : � 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.sigov.org/ehd <br /> L�koR`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: CJS ' Date: 1/ 14/14 <br /> Address: I �- City: S- &T-DT) Zip Code: �2 <br /> Owner/Operator: N h <br /> ; QW!r Telephone: 4-2-2z qci <br /> Program Element: i V)2_ Program Record: �p ©!� Inspection Type: h <br /> SB180 Posted Yes F No Permit Posted I est _ No Re-Inspection on or After: <br /> we <br /> :a Tha -a6 I l S 'Y 1\e 1S U81''G'Ke-. 1'heT�e- _0 r<C O nC` :� \ Lel\GrrC�C <br /> ire e-e P_Tn PCs , %)I cT lime. <br /> rt �elYt� 8ttatlTelr►(3er8#Ure J I1l, LSiCsi#E ` ,...a C3#L1Ce <br /> oad Safe# ertca#ion ti, a 1`a#a[ tia#1tUa#eta,:; r arewash�n <br /> F Y .< �Y v- <br /> Name: Hand Sink: -F Chlorine: <br /> �u i( ppm Heat: of <br /> Exp.Date: Warewashing Sink: j•2—Gl of Quat.Amm.: ppm Other: of <br /> Received By/Title• II <br /> EH Specialist: Phone: 2Uu 4E), <br /> Time in: of Time Out: r: rJC1 Page"�ofZ <br /> EHD 16-24 (2,d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />