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SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Cq�/Fo a�P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sagov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / <br /> L ✓4 &k)- Date: L <br /> Address: 2— �S SOL /t City: Zip Code: <br /> Owner/Operator: K i,1 &VYA �? ,n l .(/lam ly�� Telephone: <br /> Program Element: Z3 Program Record: e /6P OD�j' Inspection Type: <br /> 6180 Posted Y es ❑ Rermit Posted PC l!�Yes El Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - <br /> r- <br /> 'zywo h <br /> VLA-ea tb <br /> ay\of <br /> -}- <br /> W,c y�t V4, Gt�A.H " vj� I A A <br /> !2Z 4+4jYAAkV <br /> — c <br /> now <br /> Name: Hand Sink: /� of L,a <br /> rine: pmHeat: of <br /> Exp.Date: 2 ZD arewashing Sink ' aF .Amm.: ppm Other: of <br /> le <br /> Received By/Title: 7 r <br /> EH Specialist: T Phone: l�(� <br /> Time in: Y Time Out: j Page Z5 Z <br /> EHD 16-24 (2-pg) 4/3/13 a V FOOD PROGRAM OR CONTINUATION <br />