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SAN JOAQUIN COUNTS of <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> CgCiFoari�a. Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.si ov.or-q/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: (\DaA) Date: __7 - 19 <br /> Address: 2.2\ Off- w \ City: 1 cY Zip Code: q S 3 <br /> OwnerlOperator: Q`N� <br /> Telephone:k4ot _ 0-71 <br /> Program Element:\bO-Z Program Record: Inspection Type: <br /> B180 Posted ❑yes ❑ Hermit Posted Dyes of Re-Inspection on or After: <br /> Q; � P• 11 2-01 C n -I-1 <br /> ?roda,� <br /> O 5 _ <br /> S <br /> \ / \ <br /> ('QCq <br /> 'o 'fin UJ <br /> C 2- <br /> k,-"7 1 <br /> k �¢ ` <br /> Food Safety Certification �� <br /> Name. and Sink: � "F hlorine: ppm Heat: "F <br /> Exp. Date: arewashing Sink: 'F uat Amm.: ppm ther: 'F <br /> Received By I Title: ti <br /> H Specialist: P - Phone: 4 Io I�_O <br /> ime In: `1: Time Out: VL Page of I <br /> EHD 1624 (2^pg( 4/3/13 FOOD PROGRAM OIR CONTINUATION <br /> 4 q\w\ (zro- k �v cq�a pY-")Q'\ 6-4 . <br />