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. .g"P" SAN JOAQUIN COU* <br /> oP c <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> F. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slgov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: e Date: _1 <br /> Address: , ✓ City: Zip Code: �I5av2 <br /> Owner/Operator: ' h�R/lr v� Telephone: <br /> (408) 3r6-3&3s <br /> Program Element: 5 Progrant Record: $ <br /> O 430 Is <br /> Inspection Typ <br /> FB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> s , <br /> r-i) Sl' A "IIJJ CJ R <br /> n <br /> -- r r ja r7 d tk) S 1-i at Lf -1 <br /> La- L S S+r S - Pr-0 cry' <br /> YLA eAve n <br /> WqPfe Y r KA71 dwa sr► is Cavh a JA be <br /> r r <br /> La— � n e �.i n c <br /> O�WFFFF-�ii����.... CL) ►1... I v—e,-rv—A <br /> rr.-e- e) <br /> '1u Cgs PO CI d <br /> ML <br /> W <br /> r <br /> a� S <br /> Or <br /> y- lcV%jt <br /> Itelrn/Locat'[on ere, Item T Location <br /> 44v-f- dw 5. 1 -Lo r' !iT <br /> coo r <br /> rri a 6 L R_ Iva <br /> y << . <br /> �I�ty,�kipt�IY�tee�1'emperetur�K �' t' .gin- <br /> Name: Hand Sink: of Chlorine: Ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: PPm Other: of <br /> Received By/Title: <br /> EH Specialist. /, Phone: <br /> Time in: •o r Time Out: •J Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />