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L <br /> oPa�'N c SAN JOAQUIN COU +( �l��/rJ JSP•'� <br /> 0: X <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.sigov.ora/ehd <br /> �%FOtt <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ff) "ro G2 - r ' La n s Date: 3-41- )5 <br /> Address: all I Pa C� City: 5+70 CV_+On Zip Code: <br /> Owner/Operator: i4 Telephone: n _b 5 ,l <br /> Program Element: I (p20 Program Record: n o Saa&oG2- Inspection Type: _l koV-AeLt <br /> SB180 Posted r Yes T,Rermit Posted t_ Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> E« <t <br /> <<-( .e:+ r U t-a rc i'13 q n d v-e rw t d' r <br /> m d -e A r7-) .e L-•I-t rrn g a - <br /> V1 r Pr 4 hr -�-; <br /> `' q In rs 4 o v-e r5 h_,-4,L4_ k4- S ea r A-0-A . <br /> .e-cl h-e� s.e. <br /> ® o544- ct.+ a U f S,r,�Le- C.d c.,._-F+ 4L> {v r rs <br /> os ry a+r-oa r+i h o n j av a%h 5* C4 Y —Garr. <br /> 't rt W aa Zvi n <br /> © 00 m L clm% ✓i C'Le • .1-vl S+oL LA <br /> bI w u-K <br /> Tr i4li S al -mss _ C C�o y-e r 'Pro 04 dc ae-I•• <br /> emperature ter;, Item!Location Terdperafure_ <br /> m .t sc s <br /> Food.S a rtiffcation Fac <br /> y _ ;! ility Hot Water Temperature Warewashing <br /> Name: i Hand Sink F 'iChlonne: ppm F <br /> Exp.Date: ar washingn� /of Quat.Amm.: ppmOther: ' o <br /> °F <br /> Received By/Tifl <br /> J�rQrn. <br /> EH Specialist: Phone: / <br /> Time in: 2; J.5 Time Out: Pag Zf <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />