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SAN JOAQUIN COUNTY <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c.., ;p. Telephone:(209)466-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 9C%FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / Date: / 1/ 2,a <br /> q3 <br /> ddress: 2 Dl rh O-r N f"I City: (r L Zip Code: <br /> Owner/Operator: v �J Telephone: <br /> Program Element: / Program Record: Inspection Type: <br /> el?_n f <br /> B180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> sIsPAWVATIQ _AND CORRECTIVEACTIONS: giiIIIIIIIIIIIIII <br /> 1i ra �r r /r o _ 11 J'/X / n7-/ <br /> Z LdZ r mij KA110L <br /> 77t,4NO n GV�� m iv�uwl <br /> h <br /> _ - Food_ Now Facility Hot Water Temperature Warewas <br /> Name: Hand Sink: of Chlorine: Ppm Heat: =F <br /> Exp. Date: Warewashing Sink: of Ouat.Amm.: ppm Other: =F <br /> Received By/Titl <br /> EH Specialist: Phone: <br /> Timem'. Time Out: Page of <br /> ` <br /> EHD 16-24 (2-Pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />