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oP4V1N'.F SAN JOAQUIN COUNTY <br /> r. z ENVIRONMENTAL HEALTH DEPARTMENT <br /> M a <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> �iaav� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: _ <br /> Address: City: �^�C-AZip Code: <br /> Owner/Operator: h V Telephon Zc9)qw S' -10'7(0 <br /> Program Element: Program Record: �/ Inspection Type: A J <br /> c / <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r 00 eal a rkj 'q 6W L4 Ila <br /> N <br /> me <br /> 1A 112:54e, 64nma r <br /> WhQ Y704 AII Ole 4445, d4em ?a tCz_i'7-t <br /> e Le n ✓✓o <br /> L r ort <br /> iL Y c Ve- s oa .e <br /> e wa4e r 4L4_ <br /> 6i fiV `u r -As 4 rG l o f <br /> ra reS av--e_ e ZLL <br /> sC 5 ,0 +-75ze r r2 a <br /> r era( cat_- ;e►'rs c l re wa <br /> ocl hove_ aLL r< u4i1-e 7 <br /> r — <br /> ezl <br /> / r as i t 1,r� d oh "°° d <br /> AhAu3ane4 evyeA .5a 44.-7,q . <br /> n m s l Z d r 4.- c17"Vie <br /> V-A n !!,. s w Q i h re aGr'e.t f bofi W17 <br /> e (e To ) <br /> w rtd errks C73 <br /> Name Hand Sink: f7 of r <br /> hlorine: 1 O 6 ppm eat: aF <br /> Exp. Date: Ply <br /> arewashing Sink: >F Oust.Amm.: aooppm ther: of <br /> Received By/Title* <br /> EH Specialist: tR. - G/_ 1 Phone: <br /> Time in: /rf + Time Out: Page of <br /> EHD 1624 (2ntl pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />