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SAN .JOAQUIN COUP ' <br /> ).• '•.OG <br /> N: <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4•. �P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �fFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /_�j �� C� (r �.(�-� Date: <br /> Address: 'trio ;� K ✓k( t1(,1-­- City: Zip Code: <br /> Owner/Operator:hA, <br /> Telephone: <br /> Program Element: (o 3� Program Record: t'2`_V71 Inspection Type: <br /> IS 6180 Posted ❑Yes ❑ Permit Posted J ❑l Yes ❑1 Re-Inspection on or After: <br /> 2601 w � RVAT1t?NS AND CORRECTIVE ACTIONS <br /> e . v <br /> 1 <br /> (t1 n,(; _L44/4 ✓.1� <br /> - d IC cwv1�:-ct�.�1- rww <br /> - rum 2�t ti <br /> aH <br /> A.uA-IV,.- - <br /> CATi <br /> PA <br /> wa4 WA 11"t OCA4WAI I SI <br /> tl <br /> r 4�V,vuYN f�/�✓� t4MID <br /> /I GU/ v� c ,mit <br /> 1 GT H � � (1�I.l,�y,�-- .�.�(:LC �vf�c cti,�� � S `� (l7hG,(,Gt,z �- C�,.t yl u•��. r� /,�w�, ,/ ln'r1 � <br /> '4 �1 utiv{ fi' 3 3 <br /> t,La �ZF <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: p �' of Quat.Amm.: ppm Other: of <br /> Received By/Title. <br /> EH Specialist: Phone: Lf <br /> G1 <br /> Time in: 1 / Time Out: —/ 'Page of <br /> E1D 16-24 (211 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />