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Otcks; SAN JOAQUIN COUNTY <br /> q ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • �Q.• 9_�;P• Telephone: (209) 468-3420 Fax: {209)464-0138 Web:www.sl9oy.or_qlehd <br /> 4�os� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �« , „�� P ca Date: <br /> Address: ('u ; Y o City: 5 !/ Zip Code: 17 2 0 <br /> Owner/Operator: tl� G \ Telephone: `1 <br /> c� !� <br /> Program Element: / C Program Re ord: ! o 326 <br /> Z6 / 6' Inspection Type: t <br /> SS180 Posted ❑Yes ❑ No Permit Posted 0 Yes 11 No Re-Inspection on or After: <br /> BSE�R.�a'{��_eaes Nm40,CF / ` 3R <br /> A iON� x <br /> <J f q - 0 rill 1 c,; n C;� eq le S r <br /> c� d K Oe, r ce- of CA , r; 4- TCJ e 4 r S �G, r <br /> C, eA a <br /> V" C4 LAJ c4i h G r U 4 <br /> Com C , 4. C C G n d re e <br /> I <br /> JQ (0S'c�� cfr d i r. 1 <br /> +d IV C C crrr a c Jodcn p�� 12 <br /> 5 darn <br /> On C, P G C C1t <br /> ✓e_5 0, 11 C4 e S r er✓1 S S V rr. d: n <br /> r', rn a '15 1'P C r cs z en e\ i <br /> on co G -15 C l C ;tra tWli;4e <br /> 5hri ►rv) FCAC : 1 rc! �s SkrrM undo Cc!d <br /> Rr Gb$P v CY r\ d tari ' d'l <br /> r`n 1 c r- r ' r .� 5 h lw7F f h n r <br /> v <br /> r OPCr Gr n : � � '1 �r �fYl r? c1 �S S;nK <br /> G Yo et i er v0 U - <br /> iCc d; 9'0 Cito, C;ii -1 <br /> it v e 5 C b NA I v S h r"Zvi 01:5 U hr� 5, e'r c•� <br /> em ,o io: i m at ca io. errs e,; a to `La- e :mpe atu <br /> Og' F IAJG ,n qI ev-c,. r r <br /> od Sa a Cehif anon ao'li <br /> OR. alar :em r '„ rewas in <br /> Name: Hand Sink: G D of Chlorine: �C Lpp, <br /> Heat: "F <br /> Exp.Date: arewashing Sink: F, `F Quat.Amm.: Other: aF <br /> Received By!Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out. �! Page of <br /> EHD 15-24(21d pg) 11!2109 FOOD PROGRAM OR CONTINUATION <br />