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oPqu"" SAN JOAQUIN COUNTY <br /> p z+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 600 East Main Street, Stockton, CA 95202-3029 <br /> • �q.. �P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> rj�x) /G--�( -a 9 <br /> Address: &J 1 ry .5?- City: zip Code: 1 5-3 ?(,- <br /> Owner/Operator: <br /> 4Owner/Operator: xI A.I, 57406 56" Telephone: AW &30 7S� <br /> Program Element: 16,/ Program Record: 5 ft V 90G Inspection Type: <br /> SB180 Posted .449-rWo Permit Posted'7799--••iJo Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> F �Yvu__ y <br /> 2Abr 4T H Ar TW 3 &of'S WK TH 115 57/41 X <br /> E <br /> 209Y6 b WrO a Q /tM <br /> W . <br /> ©CV tiE ^p:> K4,nW.lu 7a ob C. rN ST. <br /> T /9uAju41- PrcmI r&f dAj5A-L 6 u r r*C C7//&V cr <br /> CK Ta 155t< Rkofer o k;16e A" 5 ,g <br /> F-S?�?-c�/2�v i' Gu t T[f J�c�g •� _ <br /> //br&j R r-/E-a_n F, 15_7&1uKtr--5s 7&W — <br /> IternlLocation Temperature Item)Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> _ __ <br /> Exp.Date: , arewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By I Title: �( <br /> EH Specialist: Phone: y 3� <br /> Time in: I I Time Out: �2 - /d 1 / Page pf <br /> EHD 16-23(2^d pg) 07/29/09 FOOD PROGRAM OR CONTINUATION <br />