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SAN JOAQUIN COUNTY`„O <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> a 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> r,, - ;a• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> 4Ll is j5W <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I via Date: <br /> Address: *C;'� -t- City: s1AKx_'._ A_Lf Zip Code: 1 <br /> Owner/Operator: , (&v."a tomTelephone: <br /> Program Element: �� Program Record: [dry Inspection Type: -,-�1 P_ <br /> 6760 Posted ❑Yes 0 Rermit Posted ss��❑Yes ❑ I Re-Inspection on or After: <br /> 0 'A 'N � r <br /> bV=I-e ed few j� \-e(I in- Ibie OrO <br /> +rnlCjl� MOA AZcV <br /> i2d CSG of - uc� cel` <br /> C ovG1 n G t� -ala <br /> n _ wCtiitrsS #z�th c�N N 1-6 ave <br /> m - <br /> "cle A+\cxl�- n�%ce_ Zte ((Jju C)-V— <br /> C we.. ._ t <br /> Wit' iS SC,M� M�` i"cX Z The VOr EC00 qun UO-­ <br /> V <br /> M� t^e----- ---_------- 1 <br /> �ct�o�l t <br /> - <br /> Name: Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm ther: of <br /> Received By!Titl <br /> EH Specialist: Phone:ucf T <br /> ime in: Time Out- rte"" page�f <br /> EHD 1624 (2n1 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />