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O.PQuIN C SAN JOAQUIN COU <br /> _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> a: -t <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siQov.org/ehd <br /> LfpoR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: U ` �-�� Date: _I4 45 <br /> Address: (Li •2 1 ma r City: ���r1 Zip Code: L.20 <br /> Owner/Operator: 11ai t Telephone: v 530 n <br /> Program Element: 10-2-4 Program Record: Lt Inspection Type: /L e <br /> t �u:� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: 3 t.u1 _4S <br /> s > � OBSERVATlON 'At+10 CORRECTIVE ACTiC)NS <br /> a.p 11 too rs -II- hl a t f 5 n" cl C Cj ct._r�- rz ....._-._........__....... <br /> _ <br /> w�-J�s - <br /> _...._.._.......'.5...._.......... <br /> h�- <br /> Lj <br /> ..............bv_ _�__hS..__.__._���+- Cn._c.-l - '_Y_.........._._►_o_o.m_.._ .f_v'-e...r....._..._._ue 5°�n <br /> rLe- ms <br /> t I D SQ -"1y-,7- 1`1 6"-") <br /> Lf 4-e.,)L e r) <br /> GLi <br /> '•• ern >rs <br /> D too Y <br /> n04b <br /> r ,rz ct.L r <br /> ►�u-P eIL� - __._ _.__ ___. <br /> 777-77 <br /> ItemlLocatton � 7em nature : Item l t.ocation 7ettii x nature <br /> Name: Hand Sink: �\ of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: �� ' d14'dPhone: q <br /> Time in: O Time Out: ��Q Page of <br /> EHD 16-24 (2^d pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />