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P4"r" , <br />SAN JOAQUIN COUt <br />o .....• <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.slaov.orq/ehd <br />LFOtiZ <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />i1 I f , \ i1 <br />Date: `?c _ A <br /><< < <br />Address:y <br />�y " City: <br />—y- Zip Code: 7 7 <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />Inspection Type: <br />IS B180 Posted Yes <br />No Permit Posted Yes No <br />Re -Inspection on or After: <br />a �p: <br />0 . <br />: <br />ain: <br />.1Kk' V10C <br />Cli' <br />& <br />Ci'(C on 4),e foe <br />nW C, I V.r free ter. <br />�• A I <br />} r( oG d ot.j C 6 ine/.e3 <br />U fT I i'e t/r✓ r, sire l <br />-5 <br />odo <br />3 r 'v,' <br />de 5610. r rs 1r�c.�•.'S <br />��Sj,,n j e r, Corr c 4c c, <br />ttemlt ovation <br />'Temperature <br />Item ! 1_ricaUon"Tem <br />nature'. <br />Certificatlon <br />Faclltiy Hp Waie►perfure, <br />.y <br />lNerewashars9 <br />s; <br />Name:�jd <br />N k <br />Sink: <br />w3 <br />°F <br />Chlorine: <br />PPm <br />Heat: °F <br />I <br />(�c., II, <br />Exp. Date: <br />Waftvffashing Sink:I j F <br />of <br />Quat. Amm.: Ppm <br />Other: of <br />w <br />Received By/ Title: <br />�► a _ <br />EH Specialist: <br />Phone: <br />Time in: <br />Time Out: Page, of <br />EHD 16-24 (2n' pg) 4/3/13 <br />FOOD PROGRAM OIR CONTINUATION <br />