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°G"�" SAN �OAQUIN COL <br /> 'Y <br /> 'o coc <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.(209)464-0138 Web:www.sigov.orq/ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> n S - -/ <br /> Address: a g Ion a rC k-L., City: +CYI Zip Code: Ct 5- l 9 <br /> Owner/Operator: WL ,A'>, Telephone: 96 j_Ll <br /> 15 <br /> Program Element: I Program Record: Ptd M i $ 3L `Z- Inspection Type: -1-2-0�I+inA <br /> SB180 Posted 4Yes No Permit Posted -AYes No Re-Inspection on or After: V sz <br /> OBSERI/AT�C7NS AN©C{ RRECTIVE <br /> r <br /> Ce✓ +; A-c.P,4-t. h o-1a ucL-� (.o_b Com- <br /> --- ................. <br /> ► o 1- H,04 _._err h )')'Z rc.`n I- •� u f 3 5 Y <br /> _ ---- <br /> Dr kt r- <br /> ,Q1 rT <br /> 4-o -Prev-t vv�- Avo8 rn 1005'10 - �9�4- <br /> v u/ -- <br /> -1- . LA)he n no us , rf <br /> e.e. 6 LA Ci L k W C-441 5 M rvA` ti Z e r, <br /> r i r, -t-D w.c-L�-3 A•JI I,-'A CIA Y- hj W-C'Z rn-L_ <br /> \ 1 <br /> 6 �[4•�- a'0 Y-' _ _. . . .o.�� _ .__� n.e...� r t� S f�_� ion/ 1�0-���-P -e n,1 <br /> a4 �I �F v r t.c�►�e r <br /> -_ C-�-�l_. . ....�a-l� . b....... .. <br /> 1'kv.e r YYy6 t a 6.els 0 o f a a-A fh Lt Pr ` It— a I-7.-( --- <br /> .......... <br /> r 40 Co ('0- <br /> It") <br /> scla -l_r ,,}12 w. +h✓W - w 4- CLf ' -�rQ e ?�ra%v-, -P►-�-� 1-c, <br /> -- -�- _.._ _U« n b <br /> `itemfLacaftt?» Temperature ' .' ftem I Location_, . . <br /> 3erT perature <br /> ro c�uc,e, c CA 1, LAO a-CK-4 <br /> rr� ro d,u cmc. u��c-Q�1r�th 3 _....... <br /> V <br /> Fodrt 5afetj+Gert�fiction Faciirty Hot Water Temperature Warewashing ` <br /> Name: Hand Sink: li-IL) aF Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: y 4-6 of Q t. ppm Other: o f <br /> Received By/Title/,— <br /> EH Specialist: 1_ _ _ Phone- <br /> ime in: I'f Time Out: Pageof <br /> EHD 16-24 (2^'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />