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SAN JOAQUIN COUNTY , <br /> 2` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 fast Hazelton Avenue, Stockton, CA 95205-6232 <br /> ••C4,Q•., tiP•• Telephone: (209) 468-3420 Fax:(209) 464-0938 Web:www.s' ov.or gjgLhq <br /> tlpOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �nQ }� ,; r Date: <br /> Address: !1 f,��J 1 ��b 1 City: Zip� -t*�ri`� Code: <br /> i <br /> Owner/Operator: <br /> �� yr:t�Q� 1"' � i Telephone: <br /> Program Element: r Program Record: r Inspection Type: <br /> SB180 Posted f es CI Rermit Posted e5 © I `•' Re-inspection on or After: <br /> oBSER'�1 -rlc lS AW1.3 CORRE+ TIVE ACTIONS <br /> - <br /> - <br /> - U- J e_ to 1�- CG C,'y, U-AClh Cifi1(A GA, J - - <br /> I I We,) d G '�-COCXG S Q-� 11AR, 2 ((M !'Muv2 UCl <br /> Conti nom. e CvA*rD - WGee/ S, 04<,_-�S CA <br /> i tiq1 ;Tl T=ry 2 c S s� 1TniAC 0m lb-C. -ICZA: 4:0meti c_ <br /> G4s P_c , <br />� �- � � h�,./.e .�� `fih.L�i�-� �-fin t.� �O f�/� � '�g�J S X11 e �-��•t ��_ '� <br /> !tear►!ocationiemptaratute ` Ite r€,Loca#ton Tem�eratiire <br /> C �Ae6 � Wit K- In 9= w KG <br /> i� 1n Coda f I CA+ C <br /> Fwd' Certification __ Facility Floc Water TempeEah ro _ alV�re►irastiin® ' <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: 11 arewashing Sink: of Quat.Amm.: ppm Other. F <br /> Received By!Title: <br /> EH Specialist: Phone: r4 <br /> Time in: Time-Out- �Y Page of" <br /> EHO 16-24 (2v0 pg) 4!3!13 <br /> FOOD PROGRAM OIR COt4T":„:=�C,.: <br />