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or.4 In. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c.., �e• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.oro/ehd <br /> 4LlFd'itN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J4&- Date: <br /> Address: �CrQf/�LL City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: ro cram Record: A P / rSV Inspection Type:�� <br /> 8180 Posted Yes No Permit Posted XYes No •J Re-Inspection on or After: <br /> E Tl. EACTIONS <br /> G - ✓7 <br /> �- J !o LP ��'• <br /> V 1-�U �(lrrr LIt07) U <br /> SdwL� �Ce- Q- <br /> rnGlllhc J F• <br /> GllnL✓ �l t �{' <br /> a011 omd�Iffi <br /> 3 rf <br /> w <br /> rtl �✓v�d t r✓� � <br /> 0n =14t�ltlppoim <br /> � <br /> u <br /> ✓vvv S I wk.— a-b <br /> ZYd <br /> —C u c ssc b 11 A r . 3(n S'ir�1L >2vF F <br /> a.{_Safety Cfert)fica Facility Hot Water T niperature " " Warewashing,! <br /> Name: (� ►1 and Sink: 'F Chlorine: ppm 11 <br /> Heat: "F <br /> Exp. Date: ►1� JAD D r�1 _ arewashing Sink: =P Ouat.Amm.: PPM that: �F <br /> Received By/Title: �r <br /> EH Specialist: vlel� Phone: <br /> Time in: J "3�'r Page of <br /> EHD 1&24 (2-P9) 4/3/13 O` FOOD PROGRAM OIR CONTINUATION <br />