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SAN JOAQUIN COUNTY <br />? 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.sigov.oro/ehd <br />CIFOR� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:%Sg Date: 1 <br />Address: -7/0 E 0 ,A/A <br />EHD 1624 12w pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />City; <br />V <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATI AND CORREC <br />P MA009JIt�LreT,ary S. <br />ACTT <br />E6pjfps t I< 1,A r, <br />w G-1,5 <br />lNSt a btS 5 s. V ISE top <br />,. <br />6.i -a4 — ba0 YZ- C0L'>v <br />F, <br />W <br />—t tJ <br />00 2wks 011& S5r—Y42o '+6F A <br />o ✓ti >AIN <br />41FDR uEva <br />g, o v b t 0 VIP <br />-c - <br />Ca04 <br />t=a <br />tAMC'k- aoM CLEAN VLoo 0 <br />� L <br />.IIIIIIIIIIIIIIism/L-"- <br />A —Ifs e00 46-F <br />on° <br />tire <br />\0 _ o 4stC <br />FMINKFood Safety Certification <br />Name: /- <br />Hand Sink: ,t D D of hlorine: PPM <br />eat: <br />F <br />Exp. Date: <br />Ware -washing Sink: o f ust. Amm.: PPM <br />ther: <br />'F <br />Received By / Title: <br />EH Specialist: e Lff (G <br />Phone: 2AO96' <br />Time In: 9, <br />Time Out: to 0.03 <br />Pagejof 2.. <br />EHD 1624 12w pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />