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1%W SAN JOAQUIN COUNT( <br /> a �•,o� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> �4tta6aHp <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.oro/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 2 <br /> ddress: 55 , , 1 .a City: ! ,� Zip Code: ZO <br /> Owner/Operator: / wW�7+ . V Telephone: <br /> FC 09 <br /> Program Element: Program Record: PR O O Inspection Type: <br /> B180 Posted yes - No Permit Posted Ayes 'u No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> IJ CQ "OW s cant.("i7Lf L(/-t"zG— Cot r <br /> [UOr C C0 ' <br /> 1klaU (>ry r 4-C ei hAi #-,.t 6 <br /> irr La c; h c0 v ca-t- rrvt c, -'0— <br /> lr CD r rem b ! <br /> Z f m kA-5 5 0 r Jae n iz LL <br /> Rae�ALEr J4 yf, r wj?a�,r-F shat&( <br /> Coss r CO rr QCs <br /> 3 Mo Ps i G W W r--f- W e Gr1 akin <br /> J;bYrs ala. t-1Oc CC cr�i r <br /> Wcfi ' ( �Cl rCi r,r..c <br /> rat mq e-- 14 s C.o <br /> Lt WP SUr� rzout` <br /> -.e d Caps <br /> ame: iand Sink: .F hlorins: ppm eM: °F <br /> Exp.Date: Narewashing Sink: of Oust.Amm.: ppm Other: of <br /> Received By/Title: .✓I <br /> EH Specialist: C.-/y .,I1. Phone: <br /> me In: 10 <br /> . 5 (/awl Time Out: ,.q Pageof <br /> ERD 16-24 (2b pg) 1118112 f FOOD PROGRAM OIR CONTINUATION <br />