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PQU�" SAN JOAQUIN COUN <br /> 4 z., ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si9ov.orq/ehd <br /> L�FOtiz <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: n 0 I+eL Ck. /1 Date: l —Z3—)6 <br /> Address: 15220'% ^U <br /> ^t City: Zip Code: <br /> �-K-ta►7 7 <br /> Owner/Operator: 64-o cx--t-o ri Pc-c-� • Ir ���} Telephone: <br /> Program Element: 1 (107- Program Record: P 20 5.2- 1 9 I spe�t� - Type:��.i.T��-.� <br /> SB180 Posted Yes` No Permit Posted XYes No Re-Insreiction on or After: <br /> OBSERVATIONS',AND�CORRECTIVE ACTIONS, <br /> _............. <br /> _ <br /> ` r Vj ) .A'rl Cir rz <br /> I,t �-ts i 1 w <br /> x \za ��@111�I+1/C10 3 yu' ? iyRlAa�Ur@� i b �' <br /> 1t@fn' COCatlOn _f: T£l�IperatUr@. <br /> Y <br /> 3clor <br /> opafety; eaon ALM acilrtyiak YVaterem�erature War@washing <br /> 3+• <br /> Name: Hand Sink: of Chlorin )OD Ppm Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: / Phone: <br /> ---...._......_.......-----✓� <br /> Time in: W05 <br /> Time Out: Page rf / <br /> EHD 16-24 (2n0 pg)4/3/13 'v FOOD PROGRAM OIR CONTINUATION <br />