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oP574!N, SAN JOAQUIN COUK_X <br /> a•®Ea'A <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> i�..,• ;r Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> V d'd'a1' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: a C 2Cc" Date: r r.13 <br /> ddress: r6 U IW j 11_ city: 1 r u c zip code: 153 7� <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> B180 Posted Yes No Permit Posted ❑Yes No Re-Inspection on or After: <br /> E ACTIONS <br /> S 5 G -1 Co11� <br /> L _ <br /> 'lJOcr r.L'XerA 147e G r„ - KP 4. <br /> a does '-I- f� CA + arr4- <br /> P 4: r S',0,% X 2 WP <br /> C <br /> i rP44rvcm 0 n 1. le, PP l4 r✓ i r1 <br /> neyit/art'3 r0a rcc,-11 �rr4 I o It5 iAn r P%CA 1h, V P CA r (.dPP <br /> log <br /> I. /Y'1 <br /> O betr� 2 oo has C brn V0 -f , I, (C <br /> 2 F Z <br /> 60 rCrJb cc rol 0^ he 0/ r. Mc vC <br /> Id'-C4 ' <br /> 0!2i Ja dMt S /1, <br /> G n o C�u <br /> ct r✓I TA 1 _ <br /> Thi rrM r nr r• hewn S ' /h i .N <br /> lA r11hr Cc id tonn n - WC, Err• CCrror /r0 <br /> rA M'r. tl - ISo' SGu 41 E &Ca d ' s - P61410 SG cil <br /> rc,dare WC, <br /> Ip _'q lr' S�Or did G 3 � / l� Ir4l (I'JRr a - 44 P <br /> Ar 2 _glo r — El 11' P Al -1 .13 . 39. 41 e OQI,1 ir We, - 1 <br /> rr!1 <br /> a - doe, P it <br /> eq )1Qr x W. IK /✓1 7I ` to Xr d, 3 <br /> ertification Facility Hot Water Temperature '..... <br /> Name Hand Sink: 'F Chlorine: PPMHeat: /60 / a OF <br /> Exp.Date: warewashing Sink: _ .:F ouat. Ppm Other: OF <br /> Received By/Title: <br /> EH Specialist: 1� ' Phone: <br /> l c TC <br /> ime in: Time Out: r� -. S Page of <br /> EHD 1&24 (2-pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />