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)�'PA�- a•Cp� �� SAN JOAQUIN COUNT <br /> w ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sogoy.org/ehd <br /> CI FU'M1 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _rDate: <br /> ddress: ya {^ s Y C1 Tr4 t Zip Code: S 7� <br /> Owner/Operator: Telephone: 6 3 6PrUgram Element: Program Record: Inspection Type: f 1^ e <br /> B18O Posted .5 Yes .- No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> I I r¢ I Z 0 lac R 's COV.1r. Prov : de <br /> i •^ U)0 ¢ Il5 <br /> 1 lits On ¢r Webs I bucK 54-C � <br /> G r f ct. ✓e 41 J; <br /> 3 <br /> IV " . 1454-4 a n d er �Gf r¢ I 0� old PYI 0 <br /> Ka M d WrAppe W , 1h dNe { 'Age <br /> PM0ve WC4ler b� ; ld4 0 rl re - o.r IPcK <br /> Cor f0c a I rN 2 0 0 W,s. <br /> ! le: le Ghct YYIn 'S 1'e aro..n - octw <br /> rodure SQlob Store LI) F 7Y1, I )� WoW n yd <br /> � d.5 1u roti 1(1 <br /> UI Ir <br /> d Safety C n 'y d, ::.r." .. .. .._'Ydarewashing " <br /> Name: 1 Hand Sink: (1 0 "F Chlorine: ppm]Heat: F <br /> glrGp. g Sink: 2 S `F Ouat.Amm.: ppmOther: e6- <br /> ZX'Ex Date: WarewasMn <br /> Received By/Title: <br /> EH Specialist: Phone: r y <br /> Time in: I() J Time Out: C Pagoj of <br /> EHD 16-24 (2b pg) 4/3(13 FOOD PROGRAM OR CONTINUATION <br />