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5 <br /> SAN JOAQUIN COU Y <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 /> 4ko'A`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: a s C-Til ip U - 7( Z Date: (0 <br /> Address: P- Qp VOW-1 n ,v.Q City: S-� - Zip Code: Qealjl�- <br /> Owner/Operator: I-An,l7il`� c Telephone: ON -Debt <br /> Program Element: b�5 1 Program Record: _ Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> 4.< - OBSEEiVAJ�ONS ANDRRECTIUEACONS mar '" <br /> 1 <br /> o C9-C+�A-i a\ We (,kvn n Cm S <br /> at oil his <br /> 4 2 ORFFP-� OV 5l-` wk l -f pit i caw . <br /> nIC- C-0 - <br /> .......------------ <br /> -n •-------------------- --------- <br /> Unh- is <br /> e <br /> :,a ca -s-,�.teiri9L-1•iCaiipri�' .3. '`= ." a`m �r�"atup`e F on <br /> - ttem7 Locati '.` <br /> s ii.,s ...�:. 3" <br /> `�:.Fr��tX Hot_ Ater em ratu`r`ey_ _ - <br /> Name: Hand Sink: of Chlorine: I PPM Heat: of <br /> Exp.Date: n Warewashing Sink: of Ouat.Amm.: PPM Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in:--C tl�- Time Out: /`A0 �: Page f Z <br /> EHD 16-24 (2-pg) 4/3113 i "t V FOOD PROGRAM OR CONTINUATION <br />