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SAN JOAQUIN COON <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • CgG1f0>'+N�P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaoy.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -;S 6 2 - Date: 1- 16- IS <br /> Address: So S f City: 6614 <br /> /6 /4 zip Code: J 6 j 2- <br /> Owner/Operator: Telephone: <br /> I Crnr SenA crlsHl-lal�� <br /> Program Element: 6 J7 Program Record: S k 0 G 71 311)l Inspection Type: n <br /> SBt80 Posted Yes No J Permit Posted Yes No Re-Inspection on or After: P� <br /> s - OBSERYA1107d ►ND CCfF3FdECTIVE'ACID; - _ <br /> U. <br /> v n ff NO 10 Ca led - -- - - — <br /> ruv, de }ucil ; fy AC, r✓tC ; n 3 inch � PJ1crS. _ <br /> Corrrrl- ; n I Wer K. <br /> U S h r n ps h., Avp P <br /> /lac', 5JP(,rn)ob1e nrA on . <br /> kF-e ' � aero r w 11- ZC'-AVyl dsu r t 1 ra <br /> CoVPre <br /> r .. .M.$ .v.^`^^^u.... 3a_�Svk 'a,'.: - '�Y RG R33s'•`— y.. . ... ...t'u»rS:::::. <br /> �fi tature, <br /> 000, <br /> "tr,;y , - ooil°5a �P>eT,ti��6on�� „s,� ��cd'r��tioi'aM1+a er emperature _ -01 as arewakhirig,�;_ <br /> Name: I �4 r of r 5 J Hand Sink: OF Chlorine: PPM Heat: OF <br /> Exp.Date: I Z, ' arewashing Sink: OF Ouat.Amm.: ppm Other: OF <br /> Received By/Title: Y n <br /> EH Specialist: '1 J Phone: <br /> Time in: - Time Out: : 1 Page of <br /> EHD 16,24 (2n0 Pg) 413113 FOOD PROGRAM OR CONTINUATION <br />