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SAN JOAQUIN COUNTY <br /> 2a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> � • r m ,N;p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.orglehd <br /> �IFOR <br /> .FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ! se il rn ez r Date: <br /> Address: r r� City: zip Code: of <br /> s <br /> ownerlOperator: b'(r.r (moi% /n g <br /> Telephone: ��_ 7 <br /> G� <br /> Program Element: ProgramPoor& Inspection Type: 1 <br /> SB180 Posted Q Yes ❑ No Permit Posted []Yes p No Re-inspection on or After: <br /> v OBSERI/ATiONS,ANDGO RCTAIIONS <br /> °r4 O C p v-e's <br /> C(� Lj k e c 0 3 }1 C -1_e <br /> Ll <br /> � Y � <br /> y- da <br /> 1 Y rr Fes. 1 17-LQ_ <br /> P . <br /> 6-71 <br /> 1 L-L? 0 Cf f e- l y� GL t�Y� <br /> II MlY / -TL <br /> (�[ �k AJq o I . rrf aLcz� #')1 ',b dCCG 4 16 p u 'F <br /> 'yam a ? - G'j F� <br /> Cam-L <br /> 1�r <br /> [tertrltrrcafGon ern erra r rit I ae. fio ;e pea re Eo rad <br /> 3,�F <br /> ad-diSafe ert�ificatiorr ;. ac'l► 4 „�a��r 'emperaf `` <br /> Name: H Si 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewnhing Sink: `F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: 3—-7 1 <br /> Time in: : Time Out: 0a Page of <br /> EHD 16-24(2nd pg) 1112209 FOOD PROGRAM OIR CONTINUATION <br /> F <br />