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a';:a'�'^�. SAN JOAQUIN COUNTY � 0 <br /> a ENVIRONMENTAL. HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232'- <br /> �•.. s. Telephone. (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> 4(fF O�ia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ). Date: --7 3,_.1 <br /> Address: 1 City: Zip Code: q S-�S <br /> Owner/Operator: S Telephone: .. <br /> Program Element: t .2 Program Record: 1 b Inspection Type: <br /> SB1 SO Posted ❑Yes ❑ Rermit posted ❑Yes ❑ I Re-inspection on or After: <br /> k iR� R10�TIQNS14N1rGORRT1 AT1Q1+1$ Y * „1 : <br /> N[_ <br /> Co 0 �k.A C CA-424. <br /> -Q— 1j <br /> - A lc_., -N--, i S � <br /> `tel'a,nrP/� Tir �o lir o � !� C ZC� J. <br /> Q 1 s I <br /> $� bLn <br /> Itemllcatio emperature': z ej >" r $ 2tL[11 LOtIOn Q B y sTC'rdtl7ers�tilfE; <br /> " °Ei�zrd,Saf$. Ce�Eifzcatipri�"-;�' � �� � '�acli�f f•t�SE�€atir.`fem rature � , '�'� ��.� �°` -W�r+r+ivash�Tx -"r �� � �°' <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm_: ppm Other: of <br /> Received By Title:.r—�— <br /> EH Specialist: ' Phone: <br /> Time in: 1 0: 1 Time Out: � Pagel of <br /> END 16-24 (21"pg) 413113 FOOD PROGRAM OR CONTINUATION <br /> 1 <br />