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"�"I" SAN JOAQUIN COUN' <br /> 'o.��.coc <br /> 4 X 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.sigov.org/ehd <br /> <<FOR <br /> T-MWjf s <br /> 3-3 q-4'30 tC� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I Date: /- rL ! 5 <br /> Address: /`�33 L City: L _� Zip Code: c� V <br /> Owner/Operator: Vat � c�- U d r V 7'196 1'"TN/ .� Telephone: <br /> I L r <br /> Program Element: 62 Program Record: l a Inspection Type:11) <br /> SB180 Posted Pes No Permit Posted Yes No Re-Inspection on or After: <br /> - l <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �� , �< 1 � �/G ✓� f t! <� c c; vt- .. = , , <br /> Z �7a.�►� I�S a f�fa5�-r c ��_cxrtr A14 _ <br /> �Jc.>O ! r At:D- !tom Ma rye !h a, <br /> Cl�rivt4�2 �-a �••d- f 8.o( cjIt✓- <br /> IJr2 0 f, /t t.fi- 1.,u t 4s i;� wx[ k- Pt* r,' eer,4x>r- 4--ec�c <br /> ak d VI(Lo 13r ka1Y- r r0a( Z'-jld <br /> �? tr a( --y' ds: <br /> C- <br /> 7) c3-C d ' r Wg 0 I ayes /"Z'c 4 <br /> 'I'r`e Sam a�� f3y�Qs �EQC�i(!154j4"ph-1 40 �bSSI�e �CallTc�oK�rtCc^frcih <br /> e 4f,-Q 510veS fa will <br /> S k\ 6.AS t- k- x- po ckqr%'% <br /> *0 Zo o COS <br /> ti <br /> <1-4— Sel-C Serv, 5oAa %i A-5_am te5Wa 44-own, Ltrn +,avk d,c d t a , <br /> ou-1k-cLr 5415 4 rr'4�11_. is putc AM45' rrie W i`( 6e & <br /> ----- <br /> �Z, l�or reP r-C- <br /> Name: Atv%a,,8,x Hand Sink: 00 4- 'FChlorine: ppm Heat: -- 'F <br /> Exp.Date: arewashing Sink: ZC7 ofOust.Amm.: too ppm Other: of <br /> Received By/Title: j <br /> EH Specialist: n Phone: --------- <br /> ime in: r C), Z� Time Out: i , 7' PageZof <br /> EHD 16-24 (211 pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />