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SAN JOAQUIN COUNT.,I <br /> 1•'�6r'FpG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(249)464-0138 Web:wWW -gov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ^/A or-, Date: 1.2-1.2-1 <br /> Address: C) —, City: --- Zip Code: <br /> r- <br /> Owner/Operator: Telephone: — <br /> ) /1 <br /> Program Element: e G Program Record: S n 0 j ; inspection Type: n N I <br /> ted Yes No Permit Posted Yes No K Re-Inspection on or After: <br /> • - ..... 4BSERYATIC3I+fS ANQ CQRF3EGTIU.�AC'C��?�S � �` �<'< <br /> I ...............-.......... - ---- —per — topbri 5 h <br /> ----------- <br /> r Goo <br /> 0 U r/►q V 0 C e'e,,7 w C/ <br /> li rn_ '1 nPer Aa�2 <br /> 1#eml aca 4.r# dem ' titre 3tem,t t.ocatEon, „ Temperature <br /> y �, <br /> l=rir'Saf, rt�fyratiart Fci }3ot;Wateremperatvre iNarewashing <br /> '., <br /> Name: Sink: of Chlorine: ppm Heat: `F <br /> f 5 1 r�.c,r1 r�C) <br /> Exp.Date: ink: -F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EN Specialist: Phone: <br /> ime in: G Time Out: {0;2 f Page of <br /> EHD 1 r-24 (2' pg)4/3/13 V FOOD PROGRAM OR CONTINUATION <br />