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SAN JOAQUIN COU <br /> 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.org/ehd <br /> �lFORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _m r-F Date: 12 —13-1 S <br /> Address: -'�' 16 a c ,G Aj -Q. City: S -TU _;L0Zip Code: 9 6 -© <br /> Owner/Operator: vi YYlgr 1 Telephone: 4`N_ LU <br /> Program Element: 1(O 1 01 Program Record: P R 0 I Inspection Type: •fes <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS, <br /> ......�LdD P�c �'y_ .S t� 1 ✓� S O r i -e t' lrl�0 i'�'1 Gt �- --- ..-- - — <br /> .........................- a.�►-�+cu.h a _- r-c-e......_._._............ c ...-.0 ._ _ <br /> - -----.............................--- --- <br /> '8 ..c �$1 �.0 �1' ez" ,i $m} rilitlC$ e -, �tJ13 Location c_ m £mpeCatU�@ <br /> �. <br /> S _.._. __ __..-....__-- `i 1� <br /> FootlSafr#�fwtwn WlrtyoYWafer, e perature VYarewashmg <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: .3 <br /> .._._. ___........_.._.__--- - - <br /> Time in: Time Out: , y5 Page of / <br /> EHD 1fr24 (2nd pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />