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SAN JOAQUIN COUO <br /> ?< ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:vvww.sjgov.org/ehd <br /> �IFpR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: aY_I MI) 5 Date: <br /> Address: �5'2� 6 , Tpo <br /> mcLo City: 54 1�, r, Zip Code: <br /> Owner/Operator: �!J Telephone: <br /> Program Element: I (C, Program Record: (2- 0 169 <br /> /tom ) Inspection Type: L, <br /> SB180 Posted ,(+ Yes 71Rermit Posted 1 Yes EI —1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 4C r i O 1r• O• c; � m t r 5 - 1'Yi-e'L a <br /> iJ OL 8.- n s-c r_z, , 'Y-�c-�' -P <br /> Item/Location r � Item l Location <br /> w. <br /> c]o r►-i4 e. Lf I°F' <br /> ..3 - - <br /> *0Iy'44#t' Warewashing <br /> Name: Hand Sink: �10Q'F Chlorine: ppm �Het: F <br /> Exp.Date: arewashing Sink:AA�� FQppmer: 'F <br /> /vG <br /> Received By I Title: <br /> EH Specialist: � Phone: qJ� <br /> Time in: t /� Time Out: 7 4 o O Pageaof <br /> EHD 16-24 (2n'pg) 4/3/13 Cl"F FOOD PROGRAM OIR CONTINUATION <br />