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SAN JOAQUIN COUNTY <br /> Nx ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> t .a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www,smgov.org/ehd <br /> '�ci�baa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f. ArlDate: <br /> Address: y-. S City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: ACII <br /> . <br /> IS8180 Posted ❑Yes ❑ permit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> bes f-R VATION 3 T1 QCT l 3N5 <br /> rrY1 r . 1. zer- c rn [l1 p�,rC <br /> tr+ iGr7, n7 WC4 rr .S !'n C' / Gr C', �4ir14 <br /> S r <br /> rrCv' rbc S411r ._„ Soci p oc4 0c1r. <br /> V I �► s <br /> 9 <br /> U V 'G �Ci1 7i G/� S <br /> _ o S n r nw. L- - - ---- -- -- <br /> OCI <br /> ✓ <br /> LLL�_s le - <br /> AR) Vi <br /> ttlLocatii0tstpt�xl ... Jeriicmi. Teiperate : <br /> CerMcWidn <br /> Name: Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm ther: of <br /> Received By l Title: <br /> EH Specialist: Phone: -.A5 �/ <br /> Time in: Time Out: / Page of 2 <br /> FFID 16-24 (2^"pg) 413.93 FOOD PROGRAM ClR CONTINUATION <br />