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aPA�In•. SAN JOAQUIN COUNTY <br />x• � Foc <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•oq., �'e• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.org/ehd <br />�RF01�� <br />F00D PRC)GRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: � O 5 1 <br />U <br />Date: 01`2093 <br />Address: O'L -rr�J w� <br />CAS <br />City: Zip Code: 52©,6 <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: RO Ll-n <br />B180 Posted Yes No Permit Posted Ye No <br />Re -Inspection on or After: <br />Al., Md.rnn <br />RnrXic ~2 CTS V psn- <br />isy / ride: <br />Rime in: % o /® 10j7� Nme uur:,1409 ragy or- <br />EHD 1624 (2 -pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />eoR1� HANd->✓2 C1501 F CAr&s POA- Som e of Tf(s aw- <br />?UP Y 66S Az& L-A CXJN 4 8-r#9 i1v GV /'t 21 P rq 5. <br />1.0.F, A+.I.D S !Y K !.N T1'4EGe, IS L�AIC1 N!XRVM <br />TN Av CE- , R E -P I --H 1N 1*7c bA <br />7. mr, 5s - 80 fv N o -r pos-rnb rvT <br />ew oe J2 5C, 'T eV -.5 7'Li <br />-re o / nl vRxr <br />N C5 4) i./ 57fir 41;n>e <br />on . F Loeatt <br />qGK-1N G00z-e2— T 3Rx-P o — Ri Ali <br />97 <br />cl —I cam --t 3S <br />S�iVK lZzAw <br />Facility Hot Water Temperature <br />Name:*eW4 Hand Sink: ! °F Chlorine: ppm Heat: eF <br />-04 <br />Exp. Date: a� — <br />arewashing Sink: /7 it 'F <br />uat. Amm.: ,O ppm Other. =F <br />isy / ride: <br />Rime in: % o /® 10j7� Nme uur:,1409 ragy or- <br />EHD 1624 (2 -pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />