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SAN JOAQUIN COL. . Y <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q•..,,....ap Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> ��xoa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -T^ G 6(211 I Date: f <br /> Address: -1�o 5 � (2- _ �. rn�.� City: L � Zip Code: <br /> Owner/Operator: 5 YYJ e-5+D 0-2-CaL.rl O Telephone: Lf <br /> to Li--Q77 <br /> Program Element: ,(.0OQ Program Record: Goo 0 -50t 8 Inspection Type: n_ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> a IUBSERVAT{UN'SvAND CARRECTIUE�4� ONS Nsg2 . .. <br /> .-._.__.......__......_............................................_..... <br /> -....__--. __-. <br /> ... .......Q..w...._..... �,a- . -e......._. ..__..... <br /> - -- <br /> _ c>Lv cu Cst st ......._.....04...04... _n_d s.��-i .. <br /> re- La - - <br /> oal envs+ e nti vv-+d.- ne <br /> - 15 <br /> " PrO v-• bDi+t-e 'S Ai r, - <br /> .1a �:-e <br /> RM <br /> ftel ovation em rature � t.00BtIOnediiperatura <br /> �'X <br /> s z acili Hot Water"Tem rature YVaietnrash�n " <br /> i=os��ia#�, rt�firt�or11 ', h► ...>.... Pe s g a ': <br /> ���,. .. <br /> Name: Hand Sink: v of Chlorine: Ppm Heat: of <br /> Exp.Date: Warewashing Sink: -F Quat.Amm.: ppm Other: -F <br /> Received By/Title: <br /> EH Specialist: _ / 1 Phone: --f$ 1,Z <br /> Time in: Time Out: , '0-1? <br /> Page Lof <br /> EHD 16-24 (2nd pg) 4/3113 •. FOOD PROGRAM OR CONTINUATION <br />