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�O.P'a .C�G SAN JOAQUIN COUN'° " <br /> ENVIRONMENTAL HEALTH DEI-HRTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ... :P• Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sagov.org/ehd <br /> gc�FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: Iv <br /> Address: I k t , l I Ni j i n �� City: Zip Code: q P?2L <br /> Owner/Operator: ?nu 1 1�L e'i, Telephone: 464-6(�t-?1 <br /> Program Element: 1j o (A <br /> U_1Program Record: C��G��G •3F Inspection Type: b <br /> SB180 Posted Yes ICI No 1Permit Posted _-"YesT -I No Re-Inspection on or After: _S <br /> t3BSERVATIC? SANCf,CdRRECTlVE ACTI0,1 S <br /> r 0 eC:i Lt�1 Ic �� 1NGl S i r` I�CIt��S 'uv' U1�� Sal OT- i _ <br /> TIS Ccmbmey -Le mc- y and U\\yVG(VS *a4Icm S VPA-fih SCSG <br /> O k7� \JM (20 v i n cl C nG -�- wosbi n1 <br /> Nntkrii DCA-Vijr <br /> +c) N- <br /> the - coo fi w f-S we q; .eme awn us n Qecla,,I. <br /> Uk Gf 1% &, U -M�f1 CAot n i C ta._W in nI w ae lc& <br /> U W V(20 IIm &t- W a Clq b _ Lh I Lo 1 f\ the 4--ccinp Si n r . <br /> ( L/P Per 6-n Si-P <br /> MAIDNIN <br /> .ia.. �.g &ql 'Z. "No- <br /> -'110 <br /> �M'mo.�F��'�,O�v, b�k Ya <br /> vY� <br /> :.2 d r J-V_v %_-�- �p-:i o (gleom <br /> l k\y- i t) '4t;F �,Iw cFG(b Lb(Cwn I I-Y`F <br /> t�;C+ I 14pOF SWCO bar' 1-0- -1;-6` <br /> r -k- -1-11" -loch ((jA2,(- . Alf <br /> Name: S, ,,e te"1 Hand Sink: °F Chlorine: bo ppm Heat- °F <br /> Ex Date: i „ Warewashin Sink: Quat.Amm.: Other: <br /> Exp. g Z� °F ppm °F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: I C • Time Out: l l UV1 �T Page <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />