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SAN JOAQUIN COUN" <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sagov.org/ehd <br /> ��FORl� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: b MeU MGr V_ -r Date: 412/ 1 <br /> Address: �,2 ���r��1 FS-�-� City: C� r Zip Code: 20 <br /> Owner/Operator: 0b i� CA V 1U�JK.Ja1 � G n ; &C 0 Telephone: 5 1_i.�S_ <br /> Program Element: i so Program Record: r nQG Z Inspection Type: CV II I n� <br /> SB180 Posted Yes No Permit Posted Yes <br /> No Re-Inspection on or After: V\1e e.y- <br /> OBSERVATIONS AND CORRECTIVE ACTIONS �"� <br /> C a1nl a m+ S Ljcqc, In \qd -t" %mvinq <br /> cm1 Sin n <br /> - o jasNve . 1Iv e M 1� '1 <br /> rXr.�LI . <br /> 1 n a r n <br /> >2e er x c CA i <br /> +� u LohV <br /> jw-e i ,oar <br /> CIWTN pctw& <br /> Item/Location ' Temperature Item/Location j Temperature <br /> Fo afety Certification Facility Hot Water Temperature Warewashing <br /> Name: Pand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date:, �', ? arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received y/Title: <br /> EH Specialist: Phone: /�-L)CA — 44,6r <br /> Time in: � "6 Time Out: U Page of <br /> EHD 16-24(2^d pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />