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SAN JOAQUIN COUN' <br /> ?, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> ��FORt•� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Q f M Date: 15/ ' <br /> ddress: �v (fir �w-� I�,{� City: S Zip Code: � — <br /> Owner/Operator: v I _au <br /> Telephone:*ZA G <br /> Program Element: + / /`, Program Record: (�(J �t GInspection Type: i-'c lC�I <br /> 6180 Posted 1 ❑WYes ❑ Permit Posted ❑Yes ❑ I J Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - u e%_-, t A r uk fiti-0- v-)\o m cry <br /> G rnQ S ViCA f - "0M M t5S CA rsj <br /> FRE1 N <br /> a,+u <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: eF <br /> Exp.Date: arewashing Sink: 'F uat.Amm.: ppm Other: 'F <br /> Received By/Title: Yom- - (t` <�'4 ti, CAN I -f- <br /> EH Specialist: Phone: <br /> 4' Vel I <br /> Time in: • V , 0v Time Out: 1 v. Page of <br /> EHD 16-24 (2^°pg) 4;3/13 FOOD PROGRAM OR CONTINUATION <br />