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SAN JOAQUIN COUO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... ;p• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s4gov.orp/ehd <br /> 9C/FpRa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: <br /> Name of Facility: 2 S� (j � i ,; <br /> C <br /> Address: City: Zip Code:, nt I rc;c 4 S " � <br /> Owner/Operator: Telephone: � <br /> Program Element: Program Record: Inspection Type: R C L1 <br /> SB180 Posted -i Yes 5 No Permit Posted -i Yes No Re-Inspection on or After: <br /> 08S 1CATlONS AND CORRf~�Tl„ E AC's NS <br /> T ...M �, N <br /> p <br /> .Sanh115C o P IGI7 <br /> , <br /> Z. D rc e Q I YSru We;q A Ccrrecj Iq tJ P <br /> rµi 4 cla CGYr e cl Id <br /> s o W cAnr Of n ^ ,n ) rune7 , n q .4 <br /> %i ; � �� ; r� 1 or 12 C IZCl CGvr fCe14 <br /> ' (t7vi DU G1mc' C <br /> fclrs: 7M, -WABW <br /> iica cors <br /> L Cc <br /> �t A - d C,16 o d w, l 0- ci ,r 7-7 <br /> �l l- <br /> Ftidtl Safety'Ceo!cation Facil <br /> ity Ho#Water errrperatuee ? fFai <br /> Name: Hand Sink: I S eF Chlorine: PPM Heat: aF <br /> Exp.Date: Warewashing Sink: -F Quat.Amm.: PPm Other: -F <br /> Received By/Title: �L <br /> EH Specialist: Phonei 3 `� <br /> Time in: Time Out: / Page of 11 1 <br /> 'i <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />