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"gw" 0, SAN JOAQUIN COUNTY <br /> Ao.- <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: (,Wu-" vt � - WM 1�p Date: vc;19/' <br /> Address: 22 N U n City: SAA - Zip Code: <br /> Owner/Operator: r l��7 rn v Telephone: 0 <br /> 2'�1 <br /> 4 <br /> Program Elemen �1 Program Record �J 2 Inspection Type: fi <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> tL �cw S$rX �c`� s G 'I (-e bin . cm c, <br /> 1A- M cx)UX 0�> 4"F NAVSk A 1" OY <br /> kN Vcu. e mf W1 <br /> t <br /> Wt <br /> ootf Safety Cerci#icat�on 's Facility Hat Water Temperature YVarewias <br /> Name: 4,�L ya J Hand Sink: ; C) 'F Chlorine: ppm Heat: F <br /> Exp.Date: 1� / + 4M0 <br /> arewashing Sink: ;�G of 11 Ouat.Amm.:h:,,-�i I ppm Other: of <br /> Received By/Title , . T V� <br /> A'�C1C..• �Cs2� <br /> EH Specialist: Phone: /�/T_ 6 <br /> Time in: 1 11 U Time Out: 1) _ �- Page f <br /> FHD 16-24 (211 pg) 4/3/13 1 FOOD PROGRAM OIR CONTINUATION <br />