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�o¢qN'"• SAN JOAQUIN COUNTY <br />a ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�4` FdRHp Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.orD/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />` <br />Date + �Z LlJZ3 <br />Address: <br />C�' <br />-�r144' #14 Sk <br />City <br />Zip Code: <br />Owner/Operator: <br />rZ7191P 4 <br />Telephone: <br />Program Element: / <br />a Program Record: 0 S� <br />Inspection Type: <br />8180 Posted es <br />No Permit Posted)(,Yes No <br />Re -Inspection on or After: <br />S AND CORRECTIVE ACTIONS <br />t <br />inn. <br />-e a - it <br />GLS <br />-/" (rn t <br />TCC <br />J ✓ytQC( <br />S <br />v`e-vL <br />^^II,�� ' <br />V✓w <br />V <br />8 I <br />I L C. <br />ct Jl n G�v`ec�- <br />✓ <br />rw <br />1 <br />VVV <br />I <br />Gfy✓ <br />t_vt,_ _ <br />(— <br />GIL <br />i✓' <br />r�. <br />w 'Lf 1 <br />u✓ <br />AA <br />Alt� <br />s� <br />— <br />L o <br />. re <br />�tecicG "Yrt <br />vn <br />ref Q - I Un <br />d_S_a_fe C <br />Name: l y,a,l- 1 and Sink: <br />of hloNne: ppm Heat: <br />�F <br />'F <br />Exp. Date: ' f�V ' <br />,L fh. arewashing Sink: <br />> <br />'F uat. Amm.: <br />PPM they. <br />of <br />ecelved By / Title: <br />EH Speclalist:- <br />VI/L l 1-t Z <br />Phone: <br />- U <br />IT ime in: 1 <br />Time Out: <br />Page•�of <br />EHD 1624 (2° pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />