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SAN JOAQUIN COUNTY <br />S+ ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />cq,•• �;�p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />�FO>; <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: �A C* N CCk Date: 2J1✓ 0f 14 <br />_ <br />Address: ' S S Sun o� t n City: Sfiu cx_Az 1 Zip Code: 1: i�2 <br />Owner/Operator: �'1�v; `Q SOIX Telephone: <br />4 —"!i-2_ <br />Program Element: `�2e} Program Record: G b }�I Inspection Type: <br />SB180 Posted Yes ❑ No Permit Posted VYes C No Re -inspection on or After: <br />OBSERVATIONS AND CORRE&TIDE ACTIO <br />i Pic a -ac <br />c <br />L� o nSthz kwd _ Kitwov e, Cly <br />Q Lt . <br />The 9, j r vele IS W- uS-t-o I 'f or our/ <br />bsay � � trte ar00. <br />Mica -n s da a wnl c cntr094- lxk <br />C(J2 tun W k S, NA CAPA V\ <br />ob 4- 1A\1e Cd U rOa C <br />at -ea. Maonkasn +go b <br />ia�o cbluono 4eA7 s i s ems. <br />NO W GJJ NA o g n9W Tle7 rQ rd ccmtack law <br />penV\Cmi S_ <br />zt�t n ifi hu "a-00 trm (;hlrniTle_ <br />dr PeiField <br />1 �r 4.1 <br />Name: I_. t V V, ` `M <br />f 1 <br />Hand Sink: 1 0U of <br />Chlorine: , ppm Heat: of <br />Exp. Date: <br />I.Z I <br />arewashing Sink: 1� of <br />Quat. Amm.: ppm <br />Other: of <br />Received By / Title: <br />EH Specialist: Phone:f0�� <br />Time in: • I 4� Time Out: / Page20f2_ <br />EHD 16-24 (2n1 pg) 413113 FOOD PROGRAM OR CONTINUATION <br />