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ip <br /> SAN JOAQUIN COUS <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: c.; -1 S T ko <br /> Address: 112y Ute) V/<3Se� 2 City: ,nn` Zip Code: 9 <br /> OwnerlOperator: 2 1 1 V Telephone: <br /> Program Element: `b2 Program Record: 1 b I �-� Inspection Type: <br /> 6180 Posted IT Yes ❑ Remit Posted ❑Yes ❑1 Re-Inspection on or After: 2 <br /> u <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> h 4 <br /> A\-Q- <br /> a <br /> ' c <br /> 2 <br /> �t <br /> L - v, - <br /> 3 T <br /> J <br /> C� - <br /> u".0- \ <br /> w' lYr�_ bJ O 1 <br /> bay Ovib� 3- 33— <br /> b 3 ►2\A F b '.'j s 130 _ <br /> w 4-4b T= W-7� <br /> S <br /> 2 yO 2r ...� 3a.F _ <br /> 4 0 F Cir z 03�1 F <br /> 3F I tc-N <br /> Fdod Safety Certifmat�o <br /> Name: 11cr- ` J E.I and Sink: 35 eF hlorine• ppm Heat: DF <br /> Exp.Date: .-1 _ 1 1 ewashing Sink: 3 'F uat. mm.: ppm they: eF <br /> R - <br /> Received By I Title: <br /> H Specialist: Phone: `1 b O3 <br /> ime in: 1 Z: Lis <br /> Time Out: Page f <br /> EHD 18-24(2n°pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />