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SAN JOAQUIN COUiiIi i Y <br /> r. ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q a <br /> r 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sioov.org/ehd <br /> L�FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Al" CJ a- / ---k) Date: 07 _ <br /> ddress: G� .` City: C ,�'Oh Zip Code: 5;k-0 17 <br /> Owner/Operator: v f.. le v C Telephone: a07_x9,s� <br /> Program Element: / &3q ProgracmRecdrg,. q A D 5Inspection Type: rReK,f,i�� <br /> SB180 Posted Yes o No Permit Posted7-yes ❑ No Re-Inspection on or After: <br /> B$tk� Af tO AND ORIF C i iE ACTIONS <br /> U� W- 5 3.7 1 5 _ F. . <br /> i j?1/-G✓4 ?A c_od,2 nurn4w a,^C W64bsirLe jZQ -at6 h 5 <br /> D- < i LA e, T4 rm-i4 r- o�"-O 1 <br /> I 'mlf.:oeatidit - TEitf talars Item/4-00000 T- etal'ure:i <br /> Food _- ety4E g w dSil{- Water T,er1) raq p a,ewa3Hat: <br /> Name: Hand Sink: "F Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: ppm Other: `F <br /> --dr Received By/Title: <br /> EH Specialist: Phone: <br /> 53 - <br /> ime in: 9;8tJ. Time Out: Q ;CVO Page4 Of <br /> EHD 16-24(21'pg) 413/13 O FOOD PROGRAM OIR CONTINl1ATION <br />