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oPa u SAN JOAQUIN COU`,fY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ' Cq' "- �P• <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.org/ehd <br /> �rFOH� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: CaWLeo CAA,-� Ceu Date: . �z-S _! <br /> Address: 5,S 1zal L+ City: 6+Oc.,K-/v4 Zip Code: 9 5 'a0 <br /> Owner/Operator: W'1 S 2Wt S Telephone: L{-7 (-1- 17`1 <br /> Program Element: 1 (OZ� Program Record: P R-O t(p O $y (o Inspection Type: <br /> S61 89 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 351F Or <br /> a rct t✓' "e"r-er- <br /> - <br /> n <br /> L.tlz+- <br /> �'Lc s A.ucx.r` a <br /> y r (Jrt.a c <br /> d � l�a n ;_4C s 4wt47o <br /> L5 rn LT e�-- - at- 6 e <br /> S dr r+ l Gyr <br /> rj <br /> u shatt 64v4-d . <br /> s w n l!- /-/ uJ e .tie c4ed. <br /> Item/LocationTemperature I; Item/Location I Temperature <br /> -- - _-__.1�! <br /> Food Safety Certification _ `�Facifity Hot Water Temperature Warewashing <br /> Heat <br /> Name: Hand Sink: of Chlorine: PPM =F <br /> xp.Date: arewashing Sink: 'F Ouat.Amm.: PPM Other: .F <br /> Received By/Title: <br /> EH Specialist: Phone: 53 _73 n <br /> Time in: Time iJe Out: 1 .11C. Page of <br /> EHD16-2412o0pg14rS13 ✓ FOOD PROGRAM OIR CONTINUATION <br />