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SAN JOAQUIN COU'L <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> �iFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5_YYVA r Date: <br /> Address: —b S ac� F C_ City: 5 C1Y__I„0n Zip Code: Ot 620L/ <br /> Owner/Operator: S&A\j-e_ YY)Ar +- Telephone: <br /> Ll(0 11-q `t3 <br /> Program Element: I 11 Program Record: P (2-0 1 (o O 20 Inspection Type: V-o c_p� »-e__ <br /> Fi�,_ <br /> 80 Posted Yes ❑ Permit Posted Yes ❑ I Re-Inspection on or After: , ujp <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l;U '12> Y.P r <br /> -F cLr t✓I t Y2j r .'t 1t;(� r n I �'� or►�r%� <br /> v I - <br /> Our- ls. VW4 v (, cit n.i` <br /> a c.P-. Df� o V K <br /> ro <br /> o� d t-1 I O� o r Lo w-e_ r pi n c) v 4-4,-P r a C <br /> a <br /> C CAU-Y, F cA u)a A P n LID �- <br /> G cis PI a Y 3t-`di°F � <br /> y r 3-7 r ej_tA -to o c4 3� F <br /> n d 30/ F 16 r) 3 B <br /> + 1 a 1 °K Pro dw `I 3ci o <br /> HE <br /> Name: at rM-12-11,,.�.H d 'Rk: � D of At" Chlorine: Ppm H -)X136 OF <br /> Exp.Date: a -1�' ar washing Sink. 13� OF Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: - C t Phone: nS _� ' <br /> ime in: Q:,lC r Time Out: �J 6 22 Page2 f <br /> EHD 16-24 (2nd pg) 4/3/1133 FOOD PROGRAM OIR CONTINUATION <br />