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a"!" SAN JOAQUIN COL Y <br /> 4 '. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siqov.orglehd <br /> <«o a <br /> j[>e Sae P V1 p n <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: YYl r� Date: <br /> Address: 4-) City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: (O t c) Program Record: Rfl I(Do 2$ a- Inspection Type: <br /> SBI 80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: 1 M 6-n4k-) <br /> OBSERVA''IONCQRRECTIVE <br /> L`I3�► <br /> b ................ <br /> __._.-___—__..___.-------------------_..----_.__...__...___._.__.____-..._ <br /> v -__.... , -e_ �� _1_.a ._.._ .._. ..._Iry+..._ ._......... <br /> RCA aP2=t00A `Cc�►%►� r fi r o <br /> r M tin <br /> se CO r) e-cLt <br /> l: .7-A - __P6 <br /> .......................... _---------- <br /> 1 --........... <br /> rrs 0,-1h 0-r\ h.-P,mo a _. <br /> -e S <br /> - +- 1 <br /> Item/Location Temperature -- Item 1 Location — - � nperatura <br /> [R v e_:s `)_e U CIA <br /> wnc)-Ljo Z5. <br /> wece a ChA d C? K. <br /> r m-1 v I LA-11 .rl -- ztol' <br /> '-'Fovtt 5afefy xert�fiCt3Uon ' 2 acef�ty HolNater, %mperature � afwashmg <br /> Name: --Toe, / � �� nk: 4-100-F Chlorine ppm Heat: of <br /> Exp.Date:•l l-I- _ I C) a 191),ng Sink: /1 I i IZ 'F Quat.Amm.: ppm Other: o f <br /> Received By/Title: _/ <br /> EH Specialist: 0 Phone: <br /> ime in: Gi ;-7^- Time Out: 1 1;�� Pageef <br /> EHD 16-24 (214 pg) 4/3113 ( I FOOD PROGRAM OR CONTINUATION <br />