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Pap.ln. SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: <br /> O :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • o'�UF6'd��'• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.or(l/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: W Date: 11lie 1 <br /> Address: �DaAR yUtMt,'-' <br /> City: Zip Code: <br /> owner/Operator: Telephone: <br /> Program Element: Progra Record: O 7 L q Inspection Type: <br /> 8180 Posted Yes No Permit Posted Yes No Re-Inspection on or Atter: <br /> a� y �.6big—EATA—fORS AND)CORRECTIV0 C�IONS�������r ro. ��c�s�, <br /> JaL_8��-3 14 9 <br /> PE (a21 / <br /> ,k IS -- <br /> ljj ` i� "=1tem/LoeaUon - <br /> maim nl2 iatuie }'-"-�'-�`- Item l;l:ocatfan-' 66 AM <br /> �_.Pe- _>.,�. §.,.gzr;W-- )Temperature; <br /> Name: and sink: "FChlorine: PPM Heat: `F <br /> Exp.Date: arewashing Sink: -F Dual.Amm.: PPM ther: .F <br /> Received By/Title: 177= 35 <br /> EH Specialist: Phone: <br /> ime in: O Time Out: r Page of <br /> EHD 16-24 (2-pg) 4/913 FOOD PROGRAM OIR CONTINUATION <br />