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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c..: P. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 <br /> "1'Z 1 VChOn Date: Z <br /> Address: � L)(0 Qcvc cm City: S s } Zip Code: q 4 2 fj 7 <br /> Owner/Operator: irLe un Qrm Telephone: rp <br /> Program Element: �2 Program Record: 6 I[ _t 1� -�� Inspection Type: <br /> SB180 Posted C Yes No Permit Posted !efes C No l�1 Re-Inspection on or After:511 <br /> 42 <br /> �MOBSERVATIOI AN,MORRECTIVE ACTIONS <br /> y, a <br /> Q moo or 1 CC �T)a onIRe ow c i ou r\ G� <br /> 2- sp' To FOD S - un S Re v'e � <br /> CCN In Wa 0 r\ 1AA i- 1n \veQ,.r-. <br /> .ec W �0 1 ra Qa VIA S <br /> OnCA cp --% -Wice-S r 1he <br /> Clean 400C19 Ond NnCAIn-Vin .eSk of . <br /> h i U i- Ca" \v DIP <br /> c - CAWr\ <br /> Ca ( h)bf cm sl - NAG ii nbgn 0 CcW CO- I <br /> ." R ue- <br /> -- <br /> "wrAlY- in (Ccup lop- - <br /> Name: as Hand in v of Chlorine: ppm Heat: of <br /> Exp.Date: Y24 are ashing Sink: 126 of Quat.Amm.: ppm Other: of <br /> Received By/Title: �-� <br /> EH Specialist: Phone: <br /> Time in: `xv Time Out: It/ , Page of:2 <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />