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SAN JOAQUIN COU0* <br /> 4 X ENVIRONMENTAL HEALTH DEPARTMENT <br /> - - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q•..• ,..�;:P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> L��oa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: .7,ZQ Date: / _/3.— f5 <br /> Address: !H 12. se ►n-��, ) -_ City: l� Zip Code: <br /> 'T"LJ C,5 _L6 <br /> Owner/Operator: Telephone: q5;L_53 <br /> Program Element: �j�3 Program Record: (I,— Inspection Type-A � v j Lv <br /> SB180 Post rG Yes N Permit Posted Yes No cli Re-Inspection on or After: /g <br /> k&" '� QBSERVATIt3NS AN©fi.ORRECTtUE AC�C?NS <br /> r;" .,.,..�.^ ...-��x'� t.,, <br /> -3.. <br /> a-Cit Lt Co C+/)-?0 OLku A.'+f'h ae r-rn.t 4 <br /> n <br /> rr 1 + -r1-� _. <br /> --.�._�5... --------- ��� r�-F��rr -ham Q ► c-e oLy <br /> ............... _PGO...._ _hY <br /> ►'►' <br /> —L J. <br /> ............... <br /> k-e_._.._..._ S�Y.I`.►� ro _......._<........._.._1. _._...... <br /> -Q ---- 'u <br /> rhAAA.ol <br /> ..... ....... ..... . ... <br /> CA- 't 4 r --= _rd SS a4- .I? L4 h r <br /> � V6AS o rA-+i•z (.c,.4-iu n i;�t �.a e �O r g- <br /> i-�-�iO►'i . <br /> i -rrbs h A&Aii ct4e r � C4A-A -<_ <br /> r L rr-t i ✓mvi -s h <br /> 11 _1160-15 <br /> W�1 o of- /� LAa R4 f3a.'('r r <br /> Ll <br /> ..... 1" ��,...... 11rl. ........ ._� _i..__. 1,r LT - _rn .__ LTJ aU <br /> f'"�"'�.. - -- . ..........----------..---- <br /> ryl rD rr (.0 ►'�v1 - i�-e ►'r4D v e, (.c c.ire ✓ • 1 .._ _ �- — <br /> Gt Gess:i_._hl. <br /> • _.............................- .- --..................._.......- ------.__ ..........--......................... <br /> _.._..---- <br /> 7 r)<\_A-e ca v d i m c7 r"--) <br /> ................................._...._..........................._..._.... ......_............_...._._._.-- <br /> 0 •II;- ern±.-i n =-4-i on ! _12,c+u r ry 4p <br /> c-z- L r»rx.e_d4 at_,1-0 <br /> �c y_yu rv_�1- : • I� W m W_ R . 15,000 (25T fit.-e_-p!?2 S►^*_5 <br /> Pa_s4y-oo ms 5 i h ao <br /> ° ey (tetYf)iiSCStIOit yam aaT9tY! [atUTB � a j ►r1 l.ocat�on .`. 1, 7empeTature <br /> 3 9 <br /> 2,a496 ✓ Cb <br /> ---- <br /> y " �Clil i�4t Water emrierature VlfaTewashln � w' <br /> ... .r - bwoc-t-- ..-Yom.,=._,...•., .' .... .a- �.i�\��\\ .. ... .u,�a" 'G�.. e ..q �v� <br /> Name: u»cIt r Hand Sink: r oZ$ I `a0 OF Chlorine: PPM Heat: OF <br /> Exp.Date: l' are ships i / dr -F Ouat.Amm.: PPM <br /> Other: OF <br /> Received By/Title: T W <br /> EH Specialist: - Phone: <br /> Time in: Time Out: W:2 5 Paget of , <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />