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oPa4'N a SAN JOAQUIN COUNTY <br /> 2r z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> •�4Y1'aC'R`��p• Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sioov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / Date: 5. _%o <br /> Address: G S AM y p- <br /> City: TZip Code: 37 <br /> Owner/Oper1ator: / �V7C' Telephone' S/(O5 39(p-70;74:i <br /> Program Element: /,0//2 Program Record: l&j f�zg Inspection Type: Ra Lf rk< <br /> B180 Posted FYes ❑ No Permit Posted Yes No Re-Inspection on or After: 5-27-(0 <br /> SERVAL D CQ CTIVE ACTION <br /> 4V '54,1014 KfAILOAP 6,1) ldr= R4469 5ff16Lb <br /> o as < A < r <br /> 2 �R 4Pe/ S <br /> e � o0r -Zo-to <br /> /Vo lrti 56Iuarl , (trS ' / 467- Alif"s <br /> S4 X- <br /> lit3p k k1ulk ALDEKt Tftf dx,T e.E aw <br /> iwt Ma S Ps met <br /> <6 Snoop s7PRA6a a So rni /F <br /> t rAAM I <br /> kd rh k y3k,,� / ,C _ tc�tTbr N Sao a,n•Mq //A <br /> tJOME aiv 7VPS eS RLE55 4+47vk !VENTER rew bws Wr dArox oR TWiztj oa Thp <br /> In,atertr Fr Twq/e-R 15 7weNFD aN fW_alr 8&t9&& /s ati <br /> S /wP-►� t Rvu u4 S- - /o <br /> "Item/Location _ Temperature Item!Location. LTemperature <br /> Al <br /> 7e: ;'� <br /> FacdltyHot Water TemperatureWarewashing <br /> Nap7 /D and Sink: IF Chlorine: Ppm Heat aF <br /> Exp.Date: A7 arewashing Sink: eF Quat.Amm.: PPM Other: aF <br /> Received By/Title: <br /> EH Specialist: C Phone: L3/ <br /> !me in: �� r Time Out: (b Page <br /> �tf <br /> EHD 16-24(2°gg)'11009 v FOOD PROGRAM OIR CONTINUATION <br />