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SAN JOAQUIN COUNTY <br />_ ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />.C•PY1F�R��P.. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: I /G <br />�1I <br />Address: I _ S S"a Lr -k <br />City: <br />Zip Code: <br />Owner/Operator: �.Hr,,f -L— ���! YLLI.�� <br />II <br />Telephone: <br />Program Element: <br />K 37 Program Record: v S 4 ]O `f 5' <br />Inspection Type: <br />B1 BO Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />SERVATIONS AND CORRECTIVE ACTIONS <br />post <br />✓ l <br />t vet <br />I LR3. <br />1L. <br />�r SS (A2 � �—� ✓v�t,v <br />Iteio%Locstio j ure <br />M Jlrl17V <br />p VICE l( <br />i <br />. <br />2� <br />iNqtlA — " 3`1 <br />tl,safety Ce[tlflca . <br />Name: kl(u iM aV 1 1,V?_ Hand Sink: <br />I r�� <br />of hlorine: <br />Ppm Heat: <br />=F <br />arewashing Sink: <br />Exp. Date: I I Z <br />-F Oust. Amm.:PPm <br />Other: <br />of <br />Received By/ Title: <br />v� <br />EH Specialist: <br />Phone: .24q 7 V IY <br />I <br />ime in: <br />Time Out: <br />r OK <br />PageZof <br />EHD 1624 (2- pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />