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SAN JOAQUIN COUNTY <br /> �-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c..J �P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.so-ov.org/ehd <br /> q�,FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Ui��G> mr-A Date: (L-)I-_-2'(,, <br /> Address: '-� Fi tk0 `` City: &m� CA-1 Zip Code: <br /> Owner/Operator: C ,d 0 (- �1 t`"'�' Telephone: "1 <br /> Program Element: SP 1 Program Record: U�3q 1 Inspection Type: N <br /> SB180 Posted 1P Yes ❑ Rermit Posted Yes ❑I Re-Inspection on or After: t l� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> f�orutin� h cI l�> In vfi. Rirt/4e- Undo Wv C,Vof- <br /> - ( eel �0� wo`l�-irck. cicjrvreC+W On Srle- <br /> 3 1emi CU S C �5 Qi .fid c n -ii-op c4 Thi I <br /> rn I , e Go e-MiCa1S k,4,0 6Qlovv fWd i-Ie4_4 <br /> curl e --i060\ <br /> Or t <br /> i Sh IS 1 Q ' T TSU t rACWS 0(-2, 0}- 2 <br /> fi- <br /> kd -, Ga to r � A�t_" <br /> "I0 c -- - <br /> a &:An�- •►S G�- �Q4j , VS fiv kaOT CA' - - <br /> Item i l.ocatEon Te erature <br /> .� �. .Mil �,-..,, t �w <br /> f�iw...._.j2Gi-C�i _ _. - - -.. .._._._..._'...._ 01 <br /> R__._.-_._.._._. .... __ lr.._........_.. <br /> WG W- n C� R ww+rn(k- I n c,v�� 1 f <br /> -M--t(/ <br /> and Safety Certification <br /> Name: CW Hand Sink: ( FF hlorine: Q I U m eat: 'F <br /> ' S UvNU l 1 u <br /> Exp.Date: f_ ryarewashing Sink: 100 <br /> 0 fJ_ _F Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> 9� '4-(ar,� <br /> ime in: L�`� i Time Out: iI : V Page')of <br /> v � <br /> EHD 16-24 (2n°pg) 4,13113 FOOD PROGRAM OIR CONTINUATION <br />