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SAN JOAQUIN COUNTY <br /> Q` �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4.• .�;;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> i <br /> � FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 0CV- ��`�(' Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted ❑Yes ❑ Rermit Posted r Yes F' I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> UG C>SCG1� 1T-e (C1 kelc-wd 01. S I <br /> 8 TUU 11 WaC CXtiS -1'S M _Y1 nwe <br /> 1 w di i t Tc 11 <br /> U nitoS [g(/r_ menu t C-i-o 1�)F , or 1 f ecAKofi L0 ipF <br /> S <br /> 90cy- WT Lwkt G 11 MBS , Cwfi ce(-+ <br /> (RC2 C�-d U\ <br /> 11 c c w 21L '\S of GP ori; n w _ <br /> Cun n�1 i- <br /> Y <br /> Name: and Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: �l <br /> EH Specialist: �. Phone: <br /> Time m: J Time Out: `RC1 Page�pf'3 <br /> EHD 16-24 (2n,pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />