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oP "�" SAN JOAQUIN COUP_ <br /> Q........0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.slclov.org/ehd <br /> ��FORl� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I ynad c) > (, n-i Date: LA- <br /> Address: I �/, S r, ) P o-u G City: 5._X4LT) Zip Code: qC <br /> Owner/Operator: 1 VQ �noU r Telephone: c1 4 ()_ bA 4 <br /> Program Element• __� 2Pj Program Record: Inspection Type: n"1 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> i Muvde Liuft cvve4s, a Sb t i S cNe4-- <br /> s 0�b4 7, Ur ems- . - <br /> "e ea t*A-'C> <br /> S (,oa) <br /> M ftcNe -arse n Com t Ansi W bb p,�cc�nfirll <br /> S (CniTM- <br /> �jj <br /> Win (cc)jfi T - asfi 4v lcT cc . ela.N . <br /> sane ovSf aywn w 1n G "s, -�oaa <br /> , i n si M eta `S red v ,nr <br /> %6 ` is vlsln yzes0"iiul C_Vmle CK& wl 4 <br /> .t r ne m ma-r Uu RadQ <br /> c&zj at W\ <br /> Temperature <br /> n <br /> COWIN c i INI-, -mQ <br /> Food 5awmfication Facility Hot Water Temperature : Warewashin`g <br /> Name: 1 l .� Hand Sink: 1 C,L of Chlorine: ppm Heat: of <br /> Exp.Date: UC arewashing Sink: 1.I2r <br /> of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: 1 U : Time Out: 'f`-l�J` L� —1 Pag2-of 3 <br /> EHD 16-24 (2^d pg) 4/3/13 1 FOOD PROGRAM 01R CONTINUATION <br />