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Pck NSAN .10AQUfN COUNTY <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPAR I MENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Cc; ., a.a�P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.segov.or /q ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: (()I I e Date: 1)/'v <br /> Address: 3 f City: S-tb04-tun Zip Code: Cl'D12 <br /> I_ <br /> Owner/Operator: t6 qUr LIn vono a CA S Telephone: 932 -0 iT <br /> Program Element, b'�Z-4 Program Record: 0e!>00 ( Inspection Type: -� , <br /> SB180 Poste Yes o Permit Posted es) No Re-Inspection on or After: <br /> QBSER11�1710NS AND C�©RRECTIVE.-AG773h19 <br /> n <br /> _t- --_s_ __o_-r_ ____ PC �p u 0 s e) u`�d haW_ �i_-------_._._._.. <br /> --- ---- <br /> I Le, 6cU S cru n-�e-f t 1z C&. 0c,- <br /> SfilX <br /> in G C,U�gr Cc-nj iaq� Q <br /> r2 cert a �e\w -e rn me 1 _ <br /> -- pest .. C UTI _ -�v.._--c'- - hCG .... V_ ..... . <br /> Cil -j=eer �-i't,n SC�+r�eA-) <br /> --.. ------ . ..... .............._ _____.__......_..._. -._. ----- - -- - <br /> 0 MVN�e-- --r m�� -�ems- n <br /> uNI SMy- w re \k iR -_ -LN__fr%r_,t _,g-m 1 <br /> PteVr -hvel <br /> e V16A rjflf and C � . <br /> to 11ocation - Te>i�i�ierature <br /> \ er_Tv_�_ pr_ep ("._(A+) <br /> lewr _- <br /> 1 CI <br /> Warewashin <br /> Fait"Sa#etji Gertrfitaia g <br /> Name: _ vHand Sink: 100 `F Chlorine: bo ppm <br /> fO <br /> eat: `F <br /> Exp.Date: ` 2-• arewashing Sink: '-ZCj of Quat.Amm.: C ppmther: o f <br /> Received By/Title: <br /> EH Specialist: !rte Phone: _ <br /> • <br /> Time in: rl ; I Time Out: ry Pag of 2 <br /> EHD 16-24 (2`n°'Ipg) 413113 `) FOOD PROGRAM;OR CONTINUATION <br />