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`�"'" SAN JOAQUIN COUN <br /> �o �coa <br /> q ENVIRONMENTAL HEALTH DEPARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.segov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ��� IS �`j J( �� 7 -2 Ict Date: 1 2( - ' S <br /> Address: ,12.0 City: Zip Code: q c 2�2 <br /> Owner/Operator: �\ ?�J-Q1 ` G\r \ T Telephone: � —9N <br /> Program Element: 2� Program Record: 1 1�1 Inspection Type: �- r-�. <br /> SB180 Posted Qes 1 No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS,AND CORRECTIVE ACTIONS: �- <br /> ------- ------- -- ------ <br /> I NS <br /> h <br /> a � x <br /> vJ i i <br /> 7�.�st 1 1 <br /> Y;Locatibt ><. ;fer petature <br /> -73Wr � aciltty Hot Vitater temperature — Waii6washing <br /> Name: 2 \ C \ Hand Sink: `( ot of C ovine: Ste} ppm Heat: — `F <br /> Exp.Date: S_ 1 1 S ewashing Sink: 1 t of Gluat.Amm.: ppm Other: -F <br /> Received By/Title: — <br /> EH Specialist: T 1 G Phone: "-A _ �3 <br /> Time in: , Y Time Out: 1 CS 2 Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />