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SAN JOAQUIN COUNTY <br />x <br />0:1 :< ENVIRONMENTAL HEALTH DEPARTMENT <br />_ <br />__ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />�POR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:Date: <br />OBSERVATIONS AND CORRECTIVE ACTIOq2tNS <br />- i (k (OU5 <br />ane <br />2- �2 C/_ �! <br />Address: a $ ('0 O W /— rw �n� City: __T <br />V+ <br />Zip Code: <br />q 153 0 <br />Owner/Operator: 51 0 <br />Telephone: <br />g 3 6 -3-7 3:2 <br />Program Element: I Program Record: P 05 -37 66 I <br />Inspection Type: <br />T2 O04i rL,_Q, <br />SB180 Posted Lj Yes ' ' No Permit Posted Yes ❑ No <br />Re -Inspection on or After: <br />-- <br />tvy-d -s <br />OBSERVATIONS AND CORRECTIVE ACTIOq2tNS <br />- i (k (OU5 <br />ane <br />WmP7.s o r'• 6L -t <br />"q <br />Z)o m CC YYl-e� - <br />i " C <br />U <br />ca+ <br />Pb_s4 0 <br />C'ua-b me r U 1-6 .0" b <br />CAb <br />—I <br />A Se La, <br />7 <br />f,.t.) ►� <br />X11 � <br />Name:7 <br />Hand Sink: 12-01 eF <br />ChW& • <br />Le-- ppm Heat: "F <br />Exp. Date: <br />crew hing Sink: I� 'F <br />Quat. Amm.: <br />ppm Other: of <br />Received By / Title: <br />EH Specialist: <br />, Phone: <br />Time in: I •OO <br />Time Out: ' * <br />Pageaof <br />EHD 16-24 (2^ pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />