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SAN JOAQUIN COU <br /> 4 X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5U r-C- CA. Date: _ <br /> Address: O c- City: 5+0C K+ On Zip Code: q 52-0 <br /> Owner/Operator: U /Yl Telephone: -/5 � <br /> Program Element: 1(.011- rogram Record: P Z Inspection Type: <br /> SB180 Posted es No Permit Posted y(Yes No Re-Inspection on or After: <br /> . . <br /> OBSERVATIC?NS'AND CORRECTIVEAGTIONS ,; 4 i <br /> _'- . ►-o a chi t n at rr1-o v-e <br /> s + +T-o --- <br /> - --_. .. Gt Yl...._. GS?m r CA- <br /> rU-`"Q -- �I.� _ _..1 -. FJ_ �- -- (.tJ C`F�h <br /> ................_.... ........._...._...._____..__..... .............. -- --- <br /> ,�7$IY1/�.DCBf�ik ` STempefBtUfe6C8t10 $Il1ECatU18 <br /> cLoo e114 4E, F _ <br /> SOD : fetyf� on - c�htyotWaier em rature Vliainrashmg <br /> Name: �1 �,� Hand Sink: ���of rind_,/�070 0- ppm Heat: �-F <br /> !1=ink:ink: 2 -F Quat.Amm.: ppm Other: -F <br /> Received By/Title: <br /> EH Specialist: Phone: 41 -43 �-� <br /> Time in: • �y Time Out: / / Page�f <br /> EHD 16-24 (2^^pg) 4/3/13 / FOOD PROGRAM OIR CONTINUATION <br />