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SAN JOAQUIN COUNTY <br /> � •.OG <br /> y` ENVIRONMENTAL HEALTH DEPARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sagov.orcj/ehd <br /> { FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r -j S73 Date: -3-14 <br /> Address: 7 4 S � _1 /' lU f r City: I roi c Zip Code: 9$ <br /> Owner/Operator: '7 e V 5 1. S" 1110 <br /> F 11 0 Telephone: <br /> h <br /> Program Element: I O 7 Program Re ord: -7 5.21 <br /> Inspection Type: Coy,5,4 14o4 ; ,_, <br /> B180 Posted 1 G Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: <br /> _ 088 1VAT <br /> llGttc -6 /U 'F <br /> I e ry, g2 ' Iwr e 61 or boveO r Cot r,-G4 <br /> AA <br /> rAr c IC bcard b Ni ad or d;a s0,- <br /> I 02fI <br /> t? ! 1 <br /> 62 ILC -- I1 'A5___0 ne 1; o,e 1 <br /> s 'S Pa LA e i a -3 e- <br /> - 0 <br /> ruin ' r\ CY ►e le a b Ic, ; GO 'F L[) <br /> GG r r e Z aY. <br /> _ <br /> 6W.ac, r b o a r of U ,�C/){, o� <br /> S Q C41 1(� n !il0 rl'r� 4 +r Cr' rr/�r.� <br /> rd L) cle . _ 0c d rn q n G r� � � n 6 G G <br /> r <br /> ae. aiptr Tatttal� <br /> Prep hle 39 F <br /> WW'afWWashf...: <br /> Name: Hand Sink: of Chlorine: ppmHeat: F <br /> Exp-Date: arewashing Sink: 11 G 'F uat.Amm.: ppm Other: of <br /> Received By!Title: L 1 <br /> EH Specialist: Phone: <br /> Ti me in: Time Out: / r-G Page of <br /> EHO 16-24 (210 N) 413/13 `J FOOD PROGRAM OIR CONTINUATION <br /> S <br />