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SAN JOAQUIN COU& <br /> W X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility- CS-" r, V Date: <br /> Address: !.� H City: Com Zip Code: 9 5 2 3 1 <br /> SOU W OS GI RV �"ti rCs'1 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> u ) : re <br /> S8180 Posted Yes _ No Permit Posted Yes No Re-Inspection on or After: <br /> n Ole r A a ac. <br /> r\ I J W e e 1�. (� <br /> S; r' 1 i lP n a �t l Or,, 6'1e i,,wle <br /> i n C KOS 0 a <br /> 3 f rA - n If r n �� / . n9 P ,i,,4 <br /> to I r <br /> I' a 1,/1 o ve ro b reel >E <br /> rn 5: n ICS r LJ n 11 1 n a 4 - ns F. -kA <br /> 1- r Cl b o vL /9-01 ClIC4 Gnb } <br /> k S <br /> Tr C4 M 1-5e 4t'So r a-1 3 n Tr e N <br /> U %1n A4• re- Cr 4; o^ <br /> r It 6,5 #c $' I we e1 <br /> 7 Sun,- ; z . 1 runr, : loo <br /> rig c <br /> 4- d oO r = U 1 Y <br /> ruLAI Ser, 13 .d' oa,) ,ht SI - yb 'F _ P - 1351' <br /> '3 y1 4 1 frau1Spn 114_sloor)- I/ / ' 1Sar R?r <br /> Item/Location Temperature Item/-,Location Temperature <br /> Tr CA U sr• ld2 doorl y! --d ver) <br /> rAtill SPr� S L� 1" <br /> �ra a I'sJpn S d <br /> „ji. <br /> Nr <br /> Foo.. <br /> d Safety Certification Facility Hot Water Temperature Warewashing p, <br /> Name: Hand Sink: Chlorine: Heat: <br /> 'F ppm F <br /> Exp.Date: t •�.� arewashing Sink: dG of Ouat.Amm.: ppm Other: of <br /> Received By/Title: C �—f—o <br /> EH Specialist: Phone: V6 v,3 h <br /> Time in: d Time Out: Page?ofs <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />