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SAN JOAQUIN COUR <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �Q.. _ ;p• Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> <<FORl� <br /> h /�aaFOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,�n LEI 1�11�Y F % } v fl`l ��IY� k�. Date: k Z-Z <br /> Address: %M% City: Zip Code: 1153� <br /> i !,Owner/Operator: �GMm As Telephone: <br /> Program Element: I Ic S �Program Record: ✓J QG 03-TI Inspection Type: L n v <br /> SB180 Posted Yes No Permit Posted Yes No✓ Re-Inspection on or After:F?"Ww6ig— _j <br /> 1� <br /> JI <br /> C.j <br /> � -► 00 In. <br /> S tvcl to M <br /> /Ar5 ti� <br /> 'Q- WMA r a \h- 3 um g4r -e ht o hk-- 2-C� <br /> I — \ tDO W r) - r <br /> m <br /> e s - 2> <br /> h3ek _1 m <br /> Vt wmm <br /> n. <br /> Temperature <br /> w , <br /> Name: Hand Sink: o f Chlorine: PPm Heat: o f <br /> Exp.Date: Warewashing Sink: of Quit.Amm.: PPm Other: of <br /> Received By/T' <br /> fO fv _ <br /> EH Specialist: l/; P one: <br /> Time in: Am I Time Out: ;� Pagel of <br /> EHD 16.24 (2nd pg) 4/3/13 V FOOD PROGRAM OIR CONTINUATION <br />