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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.sigov.org/ehd <br /> 4fFO A� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t\OA-es is CA co Or # Date: \ AbliS <br /> Address: Do -C \h d Gi City:s � zip code: GIt; <br /> II <br /> Owner/Operator: orylgm- e S Telephone: q ft � 3y <br /> Program Element: l �-�/ _ Program ecord: ep 7�Q� Inspection Type: <br /> S8180 Posted Yes No JVD Permit Posted Yes N 4 1�S <br /> Re-Inspection on or After: <br /> "F � � f�'' OBSE{ VATIONScAN RRECTIYEACTIONS � "' <br /> L. �.:.-.=.� ..ws•.-.,+-Y rs.r��- a.J.a.c4._ xv-,..r rt,�.mw, .> .-- ,�'Fi �rd �w`ac'-"�-;_: r,� <br /> \ add <br /> I)-,e CW tt W S n)QTRe at V-0S� *N� cur+ <br /> L <br /> \UtS G wen k >(pn'k rok S <br /> "oinvlin . 1.1e tai \\ `1T1e5• <br /> U1= 1ti �SS\t¢ ,lt f+st� 20 <br /> "' ltert✓Ldeahon�`' - rte, - em"i'atuie ° ,Mam1"'—�` — - " <br /> _,., - t.•_ pe_ �-` .,�a� ,;;a 1tem�Is.Locatiori r'-Ri.-T_. -_._ `.Temperature: <br /> a--- t�r :.w� <br /> 5 , SgF,00dSatety CertifjcaLohy _ a�cditRy`NdtlNater•Tempe'rature ,, ,T; -' �` <br /> Name: and Sink: A 'F Chlorine: PPM eat: 'F <br /> Exp.Date: Warewashing Sink: 'F Dual.Amm.: PPM ther: "F <br /> Received By/Title: <br /> EH Specialist: Phone: &qlb-3 <br /> Time in: 16 :3U Time Out: ,�i 1 PaAof <br /> EHD 1424 (2°'pg) 4rYI3 V FOOD PROGRAM OIR CONTINUATION <br />