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o¢QE" SAN JOAQUIN COUNTY <br /> z ENVIRONMENTAL HEALTH DEPARTMENT <br /> ✓Il: i <br /> 1868 East Hazelton Avenue, Stockton, CA'95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> L i i`ii', ? • <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> [Name of Facility: eaM �1 �, 1,ti 7 Date:ddress: 0 yrCqmCity: �AO1_lr iCCO Zip Code:wner/Operator: I l l_` 11� VI Telephone:rogram Element: Program Record: :pv, G _ G Inspection Type: �-�+ <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: <br /> - 'QBSERVAf16 S`Ak1j`C0RRECT1 EA'' <br /> �'n-i.=`. `�'-i!§;. .<Es... .ar•.; - ',�,2'Fy E�.'�y'�a�_.�, <br /> wz II 0n0r� Ulf. <br /> 3 <br /> r lieEtl(LDCatiOrl T@t17j7erHtUT@,: v, .. ,� kerTl f iAGdtllSlly > ,n .oq??'T�Cr1�TeY�tlr@ <br /> I"aud 5af {;ertificabon i'aCd fy Hot VVa#e?.Temperafttw ,- �`` ;:VltarewashiriiL f.:, . <br /> Name: Hand Sink: `F Chlorine: ppm Heat: of <br /> Exp.hate: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By!Title: - <br /> EH Specialist: Phone: <br /> Time in: y l Time Out: 11 _ O �lvU Page fof <br /> ^" / <br /> EHD16-24 (2pg) 413113v FOOD FOOD PROGRAMOIRCON(�INUJATION <br />