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P....�"`" SAN JOAQUIN COUNTY <br /> .. <br /> 'o ....c <br /> � •.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:vvww.sjgov.org/ehd <br /> gCjFORe� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1sUr.��.�-t G V W-t Date: 2/ (� <br /> Address: '30 ,! t ,1 W' � F'r�.,11 e City: S t� -tm zip Code: a52O S <br /> Owner/Operator:V `Tp`f i ` �n� , , • Telephone: 43 <br /> J-1 <br /> Program Element: A blGJ Program Record: U Inspection Type: <br /> SB180 Posted iiYes c No '11Permit Posted Yes ❑ No Re-Inspection on or After: <br /> :7V1 �/W <br /> rf IqN c AND <br /> ox Uh 100SS Gln S <br /> Of . C 2rAecA <br /> 1W ns fns i coo ta,,r " lois N usA-- hLA-%Wgp. <br /> C Wn iww ctN . <br /> C'r,�ivi s ins .�vt-i uta c UYt C n s1+e. <br /> V <br /> c w 1z uws res ins- K\s hc4�-e 1s c(A),RecAW to -,4vrjp- <br /> w 1 Iz in c coo l x— i"F <br /> t 4 <br /> rName: _ �arewashing <br /> Sink: (�U of �hlonne: ppmHeat: of.Date: Sin � 1♦�U of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: �-UG pro — 54 4AF 2•J44AF <br /> Time in: ' r p Time Out: �V_ Page ofZ <br /> EHD 16-24(2^"pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />