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Pa"'" SAN JOAQUIN COUP- .' <br /> 2: Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.sigov.org/ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r r` �� I f I (J n Date: l <br /> 14 <br /> Address: U t I P` 1y 2 City: 1! t Zip Code: '753 76 v .L� 7 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: GUa;^C <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> �r. . W � <br /> OB$ERVATl"j�w <br /> AND MRRECTIVE:=ACTICII S <br /> L�.._..h. ,Z z_ 1 o c r> 0r) c� _1(-1- : .,,K'5 n G ye- b�,.;_1�l_._� ....... _ <br /> �_✓�__._.__....._. <br /> today' <br /> 3 o d d;,S d2 Cn s e K. S 4-o re <br /> C cc, C I b le G G n C, n d <br /> C4 aS (ASed p5S cc,11 , n c n 4 . •��rS <br /> of) ) l Se 5ccc 41, h o C s C 0 r jv <br /> '01 FOOd eF 14 ' YY7,1 fl IF S -6red in reSf r ace7i .N1or <br /> o da nn <br /> 6L pen 0 l; L4 . d 4o j2 ad* n Gr 61'1 She F, S fore 'Y <br /> C le r, YN CCjj ac% ;nor h <br /> _G................. S 1 d_..__...._._ A n l 1. _-.._._....--L..�x y e c a a a y <br /> j, G c, r ,1 <br /> ItemlLacafion Temperature Item!Location Temperature n y r- <br /> .Food Safe rt�ffCon z: -�.Facihty HoY�Water Temperature Warewashing <br /> ___..._ <br /> Name: 0 V.` Lr Hand Sink: JG4, of Chlorine: ppm Heat: of <br /> r , <br /> Exp.Date: 3-1 / arewashing Sink: J� of Ouat.Amm.: ppm Other: -F <br /> Received By/Title: <br /> EH Specialist: - Phone: <br /> Time in: I Time Out: I, O �J Page of <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />