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SAN JOAQUIN COUN . f <br /> 4' ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.si9ov.orq/ehd <br /> Lf FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: .z�` <br /> Address: 2 7 f �h k City: �N C Zip Code: QS j 7( <br /> Owner/Operator:J Telephone: 7 <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> QBSERVATiflNS A1�iD G©RRECTtVE A <br /> 5 ftinn : n� � � X1- 93 F. ??'IU ;n <br /> --- ....._L <br /> 00'L................................ !- G r re G" j.-- i M Mr ek'10, <br /> 16) <br /> I c rn c a sn K ((1'N A /1 � /� q 4- /l l F) Cc r re c I _t r l <br /> ,3 Mz1u I M@5 h tri r C oG O A lnr �. <br /> D ; :5 ca ,d lr v _.—. <br /> y 0 s: / 4c,,ye1j S41ckCc.- i <br /> >� hn r 14 C)1 G lX S QenSer. Cr, fre1 <br /> / <br /> SrIC115 h in Q in b0h WC4 W- a re ncll a <br /> . LAJ..ct l I _..--°r-- --Dp—a C ---..._.__..._.1�P -_........_ ✓_v I u { v n. --... .r r �._ <br /> ? ----- <br /> P 1.6 <br /> j Q a re c"j cri {r r* <br /> V <br /> Pr4a ` i 4i Ze L� /'CWrj iIPM5 l? in ' Ae 0 f Lh C 1)ccr' cj � oo'A <br /> SGr -11iZPr )'000,2rvi chlorl-fic 0l5aiciv. )IN( f;?-10Gr- L� �c� C/i.,n-..c <br /> . _ <br /> .ter-: QA AEU .�_ .OGatlOfl f Te[t p rat <br /> ur8 <br /> 211, <br /> x <br /> 1610 C r --- 4 VF .2-docA- <br /> Wo <br /> n r\ 1 , -coo <br /> ACV•c,i t f 11 o 0;', q rr i oo Y f <br /> Name: ` o n h C 1 o 5 Hand Sink: r/ ���/ q 3 -F Chlorine: ppm Heat: -F <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: m Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: !�.3 -] Time Out: •y� Page',,of <br /> 1 7 <br /> EHD 16-24 (2^'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />