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� y <br /> atautN-:•a SAN JOAQUIN COUNTY <br /> �.••,�•.off <br /> p ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 952023029 <br /> •., :p Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> 4{1FAR� — <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1¢V� (ok(_5 .1(44 JR it,14 Date:3 3v—O <br /> Address: 1 Rj City: /wr-Wb f- zip Code: 75-336 <br /> Owner/Operator., (f 41 ",T Telephone: F'q"-5,9 9 5,99 <br /> Program Element: Program Record: & .S_U Inspection Type: <br /> [.� L <br /> J8_180 Posted ❑Yes 0 No Permit Posted ❑Yes G No Re-Inspection on or After: <br /> Y�fF� Y ri�SAh ��.�s d'� y �� �}n���+ § � FQ�{(y y�■y/��y�rylu��-v'.Y1f -:-J •e ���.dg�J1�� - <br /> ,1 <br /> 'a�Y�:Wn V' !'�w�6J.- N.�yy 'Y"T isfi ✓� ,.�::1•b5 <br /> S` <br /> o�f'C.1g�1t17` 5 `� 3� Ram �►�K �5I`�`�SE+C �S.7�a G�JE� n, <br /> Gf� L1 ,I t74 <br /> 60-1-0 Zlow,Phsriv7l8 , IAS s5 [.ay45 A r1rur A-b DIAYM6k4 ,Y " tea rev <br /> /LrL 1vE-S S EWX L T" .(J <br /> r k(711 S -I 3 D PLI841C 7W/_5 <br /> UIVR GST /4170 t3kT (!-YN SFE r•b y-F mio (! R L 7-HR06a 6 <br /> lv1ly ow o1V JZ v�2 r Th'etE rs !F '�Ig2CrG C"� f'y 09 SH 4 tw+ <br /> P"84I e 40 4r 14 e jl�. <br /> S pt` s ALIU 751STEb jtqk Ram <br /> I",.� <br /> lk� <br /> et.�ih*.h`'F ;S'$ flCBtl4n as; " 70,. - <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By I Title: <br /> EH Specialist: f Phone: L/68 —? /Y <br /> Time in: ), i c_-> Time Out:A7�1 �R3� Page f <br /> EHD 16-23 (2W pg) 11/06/09 FOOD OIR CONTINUATION <br />