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PpUtp SAN JOAQUIN COUN-i'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: l 6-1 �, ZZi%[.%� Date: J' f <br /> Address: < '1 O City: �G h Zip Code: <br /> Owner/Operator: V 'l v. �V I a Telephone: 3 2 <br /> Program Element: C Program Record: 47 <br /> 1 GJ Inspection Type: <br /> SB180 Posted ❑Yes ❑ No Permit Posted ❑Yes El No I Re-Inspection on or After: <br /> z OBSERVATIONS AND CORRECTIVE ACTIONS 4 <br /> _ �J .f_ _.,� �'1C ��J. C ✓-f LQ l V KGS C� � 6( YG�1 <br /> vc r w C en 4.*- r AW. <br /> e <br /> 44 <br /> 0 <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title. <br /> r� <br /> EH Specialist: _ moi' Phone: _ <br /> Time in: , Time Out: Pagof <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />