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SAN JOAQUIN COLIN . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c4�%;=aR��P. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s*gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L I iCT-00i ti Cn Shu• G`f 4CE,t Date: 3/ <br /> Address: ' t AACA -m a City: C—1b Zip Code: �2 O <br /> Owner/Operator: U MC0 1 �ITelephone: CA46— D1 CDG <br /> Program Element: Ib I C Program Record: K G 1(0 Inspection Type: un <br /> SB18O Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: _ <br /> OBSERVATIONS AND CORRECTIVE ACTI1 <br /> Rpt V 100(m S CO T&AW t <br /> 1 V p-T kG�sA" S'� S U t • V RW dL cbvr VS <br /> 1� <br /> 2 CTU SaV -VK Q New C3Ap u(4I'%y C vS1c_xn tirA-)-icM_ C,A rte n- <br /> OW hQX s Pyr(cm CNy W_,f Y S <br /> I f Q� FUOG� <br /> vAMQUecs ScA Q/r-bb CCS 111 Coo <br /> cAa S .. <br /> Name: Hand Sink: 'G�,I( aF Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm ther: aF <br /> Received By/Title: _ a <br /> EH Specialist: Phone: ^ 4 66- �y <br /> ime in: (� _ Z� Time Out: 11 ; Page (of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />