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°WN 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.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: n n 1 - a Y, Date: tb_Z5._ N <br /> Address: 241 W Fy'CCity: •6+_VC4L*0r1 Zip Code: 9 5 2.6 <br /> Owner/Operator: 5 Telephone: <br /> Program Element: Program Record: P �O'5 L{ -Z Inspection Type: <br /> SB180 Posted 11yes `❑ No Permit Posted es ❑ No Re-Inspection on or After: 1 <br /> ans a roc �vs A�®CORRECTIVE acr�o.v' <br /> w_o_( r f U rLa ha n dS 1 ),_o-4, <br /> Le- to <br /> S U -420 r CO L8 n L0 car; <br /> v.2,rq e V--ot4.10r b m. <br /> -+O r '(Ce- b n 5 zce_ 5 Cod C.rtCX c- <br /> 0 Y f-gI CL <br /> - cd.e-,o r TY 4,5— 7S1 <br /> .e 1 0 <br /> rExp.Date: <br /> Hand Sink, !o? ,t of Chlorine: ppm Heat: eF <br /> arew shing to? <br /> of Quat.Amm.: ppm Other: 'F <br /> Received By/Title: „ <br /> EH Specialist: T r /� , cvu Phone: Ll 53 1'� <br /> Timein: f_; ��"'� Time Out: /• ?� Page--e ? <br /> EHD 16-24(2n1 pg) 4/3/13 �+ V FOOD PROGRAM OIR CONTINUATION <br />