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SAN JOAQUIN COL Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q. ;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siQov.orq/ehd <br /> . <br /> �iPOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ra, <br /> Date: 1-1(1-16(11 <br /> Address: City: Zip Code: <br /> �� .o, U - r >u-� 5 - � w <br /> Owner/Operator: rrvs , 1i Telephone: `-G/ &4,--q-70 <br /> Program Element: &C)o Program Record: 030'D 15ction Type: CQ r-hf <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1=oyn d a-eh.--s �, A CA _ bcA rrl +0 <br /> - LA GA r ��'t of✓- r w A a-`�'c9 r» P% K.e-� <br /> O Ot.f Xk1y' UQ QWO r8 L <br /> n + 'o <br /> bb!stervaiiorio Fa c i &-s u 4-L5 c6 n-1'r-o 1 sc) r-, <br /> Sp ynk clutryt.,icals rune-1 Rerrto v4 -err .. <br /> r1 Liq LD», rr-i to a� ro" <br /> r n (a. <br /> Oo 4 walet r C,!s rnoi a.v a +e r "U 1_A-0° <br /> r kA r + 44 rnt ��C,D r r�e�4t d to+w uJe r 13 <br /> +->t r+o w ts P rJ v-4CL4- a.+ A PnA <br /> FGt.I.(a 4 yrW ar h i *1 s pLe- kakr&le1a <br /> b t-ts -15 <br /> ,4 Q 4-2 (.t. a-k-r `k t t U."cl e r 4-rw-ed: of v-,e ae,K-t a.�, �• <br /> CL LC U_A y 6 L vn me A r-e U^.e- <br /> -4j Y u C* V r 0 ri:� r 4 v-e r kA✓t <br /> Uel.C LGA Cj�n 4; '->}'y,Z k t + -P L o o r GYM e nS , <br /> Y,?_Q 5,e C(.e e.,k Q n h-iy cam- .e.c,4, <br /> Item/Location Temperature Item!Location Temperature <br /> -- -- ...... - - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: Ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: OF <br /> Received By/Title: ,y Cvt 'ZC C7 <br /> EH Specialist: Phone: S —2 f <br /> Time in: Time Out: LJ / Page1 of ) <br /> a <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />