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SAN JOAQUIN COUNTY <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.orD/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />WIy <br />Date: Q (— I <br />Address: <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />Inspection TypeRE_IN <br />B180 Posted Yes <br />No Permit Posted Yes No Re -Inspection on or After: <br />�L <br />11-a �1TI Kl <br />OBSERVATIONS AND CORRECTIVE ACTIONS, <br />5 0 0iJ - I - <br />r OW WEISEvEfNJFIEDR <br />TIJ tS /N Gt' 112E <br />I-r'THE <br />Q 112'20'Z3 <br />S r-Grtv1�I 6 ORS <br />N l� <br />N- <br />FYI C l <br />P SAS <br />N o S t N '1 U R� <br />'Ed V' r�L, <br />65 <br />—r W1195 O -C D 0 ! <br />O R -n s <br />falN612cl <br />L A tJ <br />-AAO <br />IteMLocation - ' G ` "' `Temperatdte "' ` -' <br />S t C'J� <br />/ Locatio4i <br />etilpereYore <br />mood Safety Certification <br />Name: A <br />Hand SInk: 'V� 'F hlorine: <br />ppm Heat: <br />-F <br />Exp. Date: <br />arewashing Sink: �� "F uat. Amm.: ppm <br />ther: <br />-F <br />Received By/ Title: <br />EH Specialist: <br />C.L Ak LA •tj I #I+- fZp Phone: <br />Time in:b 1 <br />Time Out: <br />: D <br />PageZof ^7 <br />EHD 16-24 (2 -pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />