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_. �. _ .-ice. � �. � L- -- �• -- --- .� � ,._ _. _ . :_Ll ._ <br /> o�Qul" SAN JOAQUIN COUt� <br /> � ' <br /> �. ••.oc <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ��•..•„ •.�;;p Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.or /g ehd <br /> L�pOR <br /> I <br /> F®OD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: '_(.:0 v 2 (00�-Yb- � Date: <br /> Address: 3!bjV', - CUA City: Comb .i,s{) Zip Code: 9e)145- <br /> Owner/Operator: <br /> C�1-� <br /> Owner/Operator: / �` b 1+�- l`" ' Telephone: 6Q,( - <br /> Program Eleme Program Record: 52 3 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> ...t' �':�'si� '-Y"�"_'.. -' -- "'.�'.va'.�rr xt=.+•�z:.r:•� �,�.�rph,�»aw••---.enac --- s. yi-Yui-:'<k.� 3='3t -<r <br /> -•e`a" 41. a xaeyr„E i rn ri:8 <br /> OBSERVATIOI�I$AND CDRRECTJV ACTT1a 9�� <br /> ..�'#�"'L-un -: '+...xr-•--n•-... ..rrM ..�...wry.. ..?.,a.aw�a -_. _...K-.. `. «.rnik.�. - <br /> C� w �V1tGA* 51S -PC CM i , s,C�p�S oJ�- ITke- <br /> W RM`S rNC 1• C VQ4 Stn Qb 01- , Ss <br /> 2 U ktt) it nod q-r) 5k- -C. WAiR if) G <br /> -V CAM i1&. <br /> iu cm Si <br /> +.�.`�c::r• -i.:.:�.. r,a. -i:a.. .;_- <tia �'.'• {- - evn .r� y.- ��:.-'c�'=:�-•r-^a:r _ �•�--•�,:y '`9b+- "!%'r3s:... �'.c5_-�, <br /> Itetn/Location �� '` - em eraturer + � s tem7�4Locatton_f �` ==x $7empe azure <br /> � •r� C o010� . � <br /> 1;' r w u ct-• F3. <xs7 � . t u := a ii - ? L7 §Ss i5 tx• -ixe' ; �}7 x= � `l <br /> •��-_ _.�.�Faotl�Safety�Cert,�f�c�'Gonr,_��� �::�Facd�r�l�ot�VUater Temperature �� s '� :��may:,� �,1N,arewas�►Eng�� � 4�:z--�;_• <br /> ._. �.._-,,.-.. _-_. :r.:.:<...r _,r__ .. ..__... Rax_ .a _.r .... _•.,=•• rsS: =�'�«�v:4.t*•+.. .. .- ...�...:a.:S.w._.:. .. <br /> Name: Hand Sink: G of Chlorine: - 1 PPM Heat: "F <br /> Exp.Date: ;1 1 ,t S arewashing Sink: i 2 -F Ouat.Amm.: Ppm Other: -F <br /> Received By/Title: <br /> EH Specialist: Phone: QW-147&C4) 3 <br /> ime in: Time Out: Page of <br /> I <br /> EHD 16-24 (2i0 pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />