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SAN .JOAQUIN COUNTY <br /> y ?; ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a... " P. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> SCiFUR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> IT <br /> Name of Facility: / / Y — h Date: /I <br /> Address: 7 Zip Code: <br /> Owner/Operator: /?� �. - Cr`/ �/! Telephone: <br /> Program Element: ! Program Record: Z'7 Inspection Type: <br /> SB180 Posted Yes ❑ No Permit Posted Yes ❑ No / Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> wut <br /> G r �v I v �I•�v� <br /> u ,f vh cru <br /> ✓te mh- C✓o cr- aj- t w� , 947t�a <br /> 'i 1 Qr vevv"kiG- <br /> w 7 <br /> -IYemlLocahon xr�., " - � r Tempgratur -? �' '�, _ Ifem 1�Locatlan '� ;_ '� ;`fertipeFaEure <br /> 4/V RVIe"`Gi <br /> v <br /> G' L <br /> H Pqvl. <br /> od Safet .Certifica4lort%--'. >., Faciltty,Mot WateYSe'n{iQrature " i "1 <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: J-FExp.Date: arewashing Sink: 'F Ouat.Amm.: ppmOther: <br /> Received By I Title: <br /> EH Specialist: 1 - Phone: <br /> Time in: Y.".y Time Out: (Y Page'zf;� <br /> EHO 1624 (20°pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />