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aP°'g'N• o SAN JOAQUIN COUNTY <br />1• oEd' A <br />?� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />4l FO F� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: a ZZ 47 <br />Date: �� oma-✓ <br />Address: City: <br />Zip Code: <br />Owner/Operator: 1 rn wt <br />Telephone: <br />Program Element:( <br />'1 Program Recor Oj D -D (�S <br />Inspection Type: <br />y� <br />SB180 Posted Ias No Permit Posted es No Re -Inspection on or After: <br />—I V'- S Un Mt <br />17V 1 <br />V\th,,N -tom V ►1/1,fi` 0 <br />if <br />4I <br />nv- z - <br />(J O!.liF�r. � m ✓ <br />�-� <br />/ <br />Wuti1 <br />Iv v� � ,• <br />� 12 �M W�t,�t Vika,/ <br />W`6'•0 <br />0& <br />Gtv`t vt A/ Gt <br />f L C tact <br />v vvw t . <br />k2✓ <br />- M <br />-t VK <br />��r- <br />QVJKJNTOK�-� MOW <br />fV ih I IZ VU <br />htk-Lvn <br />✓ <br />—� <br />,^ k <br />_ od Safety Ce[tl8_ �. <br />V <br />_ .Facility Hot Water Temperature. <br />►.tA.t, xiiwV <br />IOy F <br />Name: Hand Sink: of Chlorine: <br />PPM Heat: <br />=F <br />Exp. Date: ?4117,arewashing Sink: of Oust. Amm.: <br />ppm Other: <br />=F <br />Received By/ Tit l ,_,_,y L/ <br />EH Specialist: , l \ Phone: 1 0 <br />ime in: 1 ✓ Time Out: "vPbge <br />_ LP ' O <br />of Z_ <br />EHD 16-24 (24 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />