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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �;.. ;P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s4gov.org/ehd <br /> �%FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: a r+ FinQ ' Date: <br /> Address: Hz2" me-r Ln City: (5+_0GKW�lel Zip Code: 496 9L_to <br /> Owner/Operator: 5I A Telephone: 12/6 <br /> P-1030 <br /> Program Element: 6 l7 Program Record: t0/2_(_),5 --2--47'790 Inspection Type: 72_.0Gc fi.ru <br /> SB180 Posted Yes ❑ No Permit Posted Yes ❑ No Re-Inspection on or After: <br /> OBSEROlATIONS AND CORREC IVE AC TION <br /> 281 <br /> in A b rMA41 ` +c>r el nd V-e mz <br /> V-e.R a+- 3-cork W sk a l,t ba� <br /> Y k4lq l4 r - <br /> �- r no+ aj- Pt L4 <br /> ►'n-1 S <br /> Usina, 3--C•f� 11'LS-Z V� I-eg i - rh <br /> - WC4 re w a 1-•.t` <br /> n Is - '3. +i <br /> cS -- e L V_T o+ S' hon <br /> -LAS 43M <br /> +-1-0 0 m <br /> ►- r rYt.[. <br /> Case Vj Aarn s -rt c.a nVA .-' 3B <br /> !Iu! a r C.r;�t 3Gi <br /> 3 to OF <br /> Name: (� /`��]/� ,r Hand Sink: Chlorine: H ° <br /> �l'I Yl R `J"I I V I/I p 135 °F ppm 1�6 F <br /> Exp.Date: '�_ �q r] arewashing Sink: IL35 °F Quat.Am m.: ` 0 D ppm Other: °F <br /> Received By/Title: �V Y1 O A <br /> EH Specialist: I 1 L Phone: <br /> Time in: ( U�� wt� /t-GILT Time Out: A 210 Page of -.7 <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />