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p . . ... 1+.r SAN JOAQUIN COUI,,Of <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaay.orglehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: U- U r I+t s� C P , [r �� Date. <br /> Address: �a Cn ruUU540A LLCity: S 4 ✓n Zip Code: g 2G 6 <br /> Owner/Operator: J u Zi r1 e r n C1 Z �+ l� Telephone: Uv r -) 9 2 <br /> Program Element: +f_z I Program Record: 2 Inspection Type: 7 J <br /> lYJ L � -�/13 Pic-�.� <br /> SB180 Posted '.Yes No Permit Posted Yes No Re-Inspection on or After: <br /> '08SERV ATION AND GORRECT11/E AG�#Qt415" <br /> U S, <br /> ocr� IIICAr�Ay lr C 145-5 1'P Ce n _0 v <br /> hr 11D 0 in Ce 0 C a ✓ a, <br /> -- - <br /> A 1 C 1-n e r G re <br /> itemlLddati6m Teta eraYuia f Locatigt7 Temperature <br /> F;iod"Safety Certicatign, FaGl3rty ai iNalerempetatl rre 1�YarewasltiCtg <br /> r . <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm r <br /> ther: of <br /> Received By I Title: Pr N <br /> EH Specialist: Phone: <br /> Time in: i, �t( time Out: � Page, of <br /> EHE 1&24 (2-pg) 4113/13 0o FOOO PROGRAM OIR CONTINUATION <br />