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C4, SAN JOAQUIN COUNTY <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 /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I &A " r—A 1 61911--L- Date: —01 —y <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> Foo OkQ <br /> WE h! pcc tLA nl I �c OX RfiVMV <br /> rr--Nt7j- FlerAlrA1^1 .4 t4 b PP-4 neo W 5J 4-0 V • o/e • <br /> w i-t 0 n A jeik- <br /> Z <br /> D o t s1 - 8 <br /> Moog <br /> oh rt Tem re <br /> SAN o V-p2 cao0 uk0r <br /> oiv IWL - 7F - 63 0- <br /> ? L- 600 -s; P <br /> Rl--& — 5115#91W >- -gLC— /990 <br /> Food-Safety,:Cerdflcaflon i <br /> Name: N Hand Sink: t nin eFhlorine: 1,0C) ppm Heat: -f <br /> Exp.Date: arewashing Sink: ,�1� -F rust.Amm.: ppm Other: -F <br /> Received By/Title: D <br /> EH Specialist: OLIO ud 0-6> Phone: <br /> Time in: /-7 • 51Ir AW Time Out: y , O 0 Pagrp oiy <br /> EHD 16-24 (2°'pg) 4IW13 FOOD PROGRAM OIR CONTINUATION <br />