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SAN JOAQUIN COUN . . <br /> 2� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �;.. ;P. Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: CCAhoIn L n r Date: rS <br /> Address: "O(o VA V' aOP.C1430 City: Sib(,*.W Zip Code: (SS L <br /> Owner/Operator: CU�O � G aQ n h� Telephone: 4.441 <br /> _ I <br /> Program Element: t�7JZ Program Record: 160lb-1- Inspection Type: <br /> SB180 Posted Yeso Permit Posted es No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTI(7N <br /> WGA �CCTM I 1 S CAuSt- <br /> I - <br /> pRovi Q SUn%-"I ane ae5"i- S CJIS Edon cA S <br /> i bLl <br /> �7-Piv i CU( T-n I-,Pe-LAi L crT-t 0T C_,.4e . <br /> I df F ichcAiFe. <br /> 16 r "rck C A+avA o r- <br /> r Ernan Ul- <br /> Name: Hand Sink: I OF Chlorine: ppm Heat: 'F <br /> Exp.Date: arewashing Sink: il,s— 'F uat.Amm.: ppm Other: of <br /> Received By/Title: O _ <br /> EH Specialist: Phone: /�()"1 <br /> Time in: 1 C. W Time Out: k . PagelofEHD 16-24 (21'pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />