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°"'" SAN JOAQUIN COUNT T <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s4gov.or /q ehd <br /> �/FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Cam CA, M'Q C'C qN 4., Date: 2_ (Cj —( <br /> Address: jLI,o City: Zip Code: <br /> Owner/Operator: S 4 h C/_Q.Z 75d: 4-Fe,''lCX Telephone: <br /> Program Element: 6' `_ �'1 Program Record: 0 014 y Inspection Type: Re 4 / f P%A- <br /> SB180 Posted JLYes [I No Permit Posted - es ❑No Re-Inspection on or After: r <br /> OBSERVATIONS AND CORRECTIVE ACTION, <br /> cin a S W <br /> 2 <br /> 410 <br /> Co r AA r— ccw r +t L-e' #is b rQkq^ fie Qsz^ �1-� 3 s1 n k u <br /> 6 t` tio— <br /> 11&N& C — <br /> Name: �1 Cr.{Z Hand Sink: O L of 015,4Chlorine: ppm Heat: of <br /> Exp.Date: K I l_ _ arewashing Sink: 131 of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: 9 Phone: _3 Ww'g— <br /> ime in: +'� Time Out: -2: Is PageZof <br /> EHD 16-24 (211pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />