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°"'" SAN JOAQUIN COUNTY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. a;P. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s4gov.org/ehd <br /> LfFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 14 Jcd �j( 0.CDL5 Date: 3 -5-- (�t <br /> Address: <br /> S"- <br /> ddress: 2C) `K 'el-wq City: Lad° Zip Code: 9S 114'0 <br /> Owner/Operator: Telephone: <br /> ©r'�I'Zj ear � <br /> Program Element: Program Record:7c,r(.0 'I�- Inspection Type: '2- <br /> SB180 Posted�<.Yes ❑ No Permit Posted,-WYes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE,ACTIONS ' <br /> a _ Co <br /> r_z 77Tizaa �— <br /> 77 <br /> o -FO - f'L�ri da.•� <br /> s ea m it a '. Re ca, dcx�r <br /> ced <br /> I . C 4 `� I s klr1 <br /> VvtC n � 6 <br /> 7 ll.X� <br /> f' cif" n s <br /> AC, r (eqA(2 6 <br /> ',- � fl W Q vr�Cl+� ' <br /> �� TI f3k C_Q - 2-or <br /> Z or- 3 C7° <br /> \­.> C srL OSI= <br /> 1 I L M4eC, <br /> rte, <br /> Name: L i Ortl�� Hand Sink: r©V^ ,� of Chlorine: 'O ppm Heat: of <br /> Exp.Date: -2- arewashing Sink: 2� of �Quat.Amm.: ppm Other: of <br /> Received By/Title: E 2-r-' 2 - <br /> EH Specialist: „/� Phone: C(b �7 <br /> Time in: ( I :y w�K Time Out: D Page-Zof L <br /> 1 r2_ <br /> EHD 16-24(2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />