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SAN JOAQUIN COUN <br /> �o •c�G <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> T 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. P Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r j Date: <br /> Address: 50 3-;3 S *-w op City: r.�-,.,; �.i,-n Zip Code: <br /> Owner/Operator: r f:o0C1S U� �1 wF- Wt Telephone: cv3+ 0(C <br /> Program Element: l b2� Program Record: p) a2 �� Inspection Type: W,b�1D <br /> SB180 Posted GYYes ❑ No Permit Posted GlYes ❑ No Re-Inspection on or After: <br /> OBSERVATION,§ AND CORRECTIVE XCTt�NS" <br /> ,S(lr�le n rS U 4xz Q • f 1 u <br /> ¢&IOC . <br /> SGhi _V�f S- I a +a- q CSM "qX-� -fia t <br /> mat hjac1 S;�W�e 11 aw k.�,j 'Fri Food . <br /> �ncI" CQ OS CM b 4e <br /> I NF"Ty" Mona off= k021 / r-T e� IDW <br /> Vw v WC ;n(�76406 d-r'- Gr <br /> -,sQ1ad1 1 S(11adres9aid VFM <br /> Wtv L4v- aQue le lite, SW C O C LOr 3U"� <br /> SCAM wvio hnfis �o►v 13S`F (or q �r- <br /> u 40" IT& f v'1 <br /> I dr a�tP.�' � WA1� i n c�t�-f t�•F <br /> Name: ' Mur+t Hand Sink: 1 of Chlorine: U ppm Heat: of <br /> Exp.Date: I� eL� arewashing Sink: 130 o f Quat.Amm.: ppm Other: o f <br /> Received By/Title: <br /> EH Specialist: ✓r1 Phone: 9,C) <br /> k w e 4 Jt ro <br /> Time in: U ; Time Out: lto OG `T Page <br /> EHD 16-24(2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />