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,oP4 .goo SAN JOAQUIN COUP'- ' <br /> ENVIRONMENTAL HEALTH DEt-ARTMENT <br /> • 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �iFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1aa 21-6] -�CI ` n r Date: :j-r'ZZ` 1G4— <br /> Address: �5 t N 2 G City: L' Zip Code: qPo 7- b <br /> Owner/Operator: �joi beTro ` (A Telephone: -}-2}. <br /> Program Element: f U() Program Record: v 0�� Inspection Type:cG0 ~toi <br /> SB180 Posted Yes l No Permit Posted Yes No Re-Inspection on or After: <br /> ob1 ( S �oc� a inThe <br /> OrI6 Live vt w <br /> o Si�.21 wry T o - 9 0 'Po <br /> lir" ia b-� f V_�- 1 Q U t3l 00Sfiv�I�S <br /> a r .Q S GX q UZ u <br /> EXSC) t ml ru r CNN n P <br /> CX1CA V A_ n U 1 ' vMCAUa <br /> Cbn cvA - <br /> 11� C'RP�(1-4- Sfi Cc�f'cfi'fa a <br /> "Uz <br /> HEMMER �,. 3emperatur <br /> 11 <br /> Name: Hand Sink: of hlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amni PPM Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: il a .r n Time Out: I( -. 1D IEJ v Page of <br /> EHD 16-24 (2na pg) 4/3/13 O V 1FOOD PROGRAM OIR CONTINUATION <br />