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SAN JOAQUIN COUNTY <br /> ..X ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> tlFbRt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: fro� �Sg r 11 Date: F _ <br /> Address: 100 if, LOL,_se ] City. L 7 k, Zip Code: L <br /> v _ - � a 953 <br /> Owner/Operator: �(4 'f Telephone: <br /> Program Element: 1� v� Program Record: Coo O 91� � Inspection Type: a✓Yl I a <br /> B180 Posted I ❑Yes E Rermit Posted Ll Yes C I Re-Inspection on or After: <br /> '003W Ml O.N�-AM : <br /> f) -IC CGSIa, nGn� ands - war r <br /> r, Q, <br /> OOCLL� 40 o. t~ I;.rv11a C +v hVe5e but t �a[u Cir~ aA <br /> CI\Pe52 Vur (r 4h (ACCV\ r, b e (' / ' +, G u <br /> 9- S - urs 0rA 4\n C � � — — �; rnrrkeOR h <br /> �3eCAKr} s or Mac re ! c 4 he <br /> SCAu ! . <br /> S 1)s (Alar,Yt« 1e h e <br /> ---6 Q + 40CUs r , rL? CC' " ve <br /> fcv CJ'_ fel\J I rCA i 11 f\ 1 U)0,^ IC <br /> CG S hoIr Own Proylfrjres <br /> nt� j S40red_ in 5ani r ___-- <br /> ,A c K �cPon W cis h S 4G Qn C1' <br /> r' in Cr r 1 SG <br /> O Ci d M - t' A1C I SGS G r c <br /> -7 —----- <br /> re (e ; V9 d a r P ryl a L`/e a n f 1 c Z e n GS 1 T h a w s .----.-- <br /> XPS of Cc5 )n l r S P o� <br /> San <br /> TO, rturt' h. Lim", <br /> erre <br /> X11 i- 7V C Co I (- c- <br /> - -� - --- --- ---- ------ -- ---- 1 -r - G.cU - <br /> ftotwator em .t+# ,;:` 1NAII ." <br /> Name, Hand Sink: of Chlorine:jo`a. �Ga ppm Heat: of <br /> Exp.Date: arewashing Sink: 1 3 aF uat.Amm.: ppm Other: of <br /> Received By 1 Title: <br /> EH Specialist: Phone: <br /> time in: Time Out: Page of 2j, <br /> EHE 16-24 (2^d pg) 413113 FOOD PROGRAM OR CONTINUATION <br /> S <br />