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a�ln SAN JOAQUIN COUNTYd <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> a; <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq.... ... P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> CIFOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: cT lDate: t l 9w- l 1p <br /> Address: �,�� �� City: Zip Code: qe,,qo'J <br /> wnerloperator: �� r„1q wCn1 Telephone: <br /> Program Element: r I Program Record: T'Y'G 'I;P2� Inspection Type: -nc an <br /> 8780 Posted ❑Yes D hermit Posted D Yes D I Re-Inspection on or After: �" <br /> v 01A0ionS Currgoed Q <br /> l lc_e SC SCU f-'66 in tekl wo"en . g4m'e <br /> 1� G <br /> 2� swe wl C"wjbS .e on 'Chi curry• .e rn <br /> n Ifii wc)cPh w4eN No+- }n u <br /> Item/L_ocatio <br /> r Food Safety Certification <br /> mme: a..-S ink: .F hlorine: PPM Heat: 'F <br /> arm <br /> _ arewashing Sink: "F uat.Amm.: PPM ther: 'F <br /> Received By/Title: (y`� <br /> EH Specialist: Phone: r1 rtry _ (0.b _ it <br /> In me in: --- - Time Out- ed-- C �1 Page of f <br /> EHD 1F24(2i4 pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />