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a"`" SAN JOAQUIN COUP <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.or_ /c/ehd <br /> ��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: CCA F-0-1 LI2,F--i U 4 U -_l(a Date: 2`/'�- <br /> Address: L 74 City: �L 1Un Zip Code: q 6 2-0 <br /> Owner/Operator: i nG1 O Pt <br /> G Telephone:04 ._01FSU <br /> . <br /> Program Element- .\U'-;�' Program Record: o 15 2 ;b� Inspection Type: �t -e <br /> SB180 Posted Yes No Permit Poste Yes No 1�'1 Re-Inspection on or After: �--- <br /> OBSERVATIt?NS AND CORRECTIVE ACTIONS <br /> - _... i_�_ _S_ _ _Sk i�1 tAC. G 01\ M Gtt1 - C�Uf Pl=t�� C41=�G__. <br /> --__ __.S..................._ -n fo w t ul <br /> Rd _— Pi-lz---�1 -�_�_ was ------- - ----- <br /> cry- _ __ <br /> ...... --------- _ - - - ______. <br /> Gia- Our m- i � K ck� cl--• l to <br /> vK vje' CC/,f-vo ct u. <br /> ._ .......---...-.... <br /> ......- - --- ------------- - -� - -- - <br /> fuOC� _MIn� `S S(LK GQ�FhiCC,�-e-- i <br /> [u`rj24* cam, 1R W Oc( S <br /> S OYA Cu _nc - - --poi. — C� cn lo-. <br /> -MOAC U' - c0 oA C v) - co ca S Un �1 <br /> -suni cX� -i oc; a\ <br /> CA <br /> Ri�L eCPf►S - 1n � `3'�-I(FCG`� <br /> M. _� Wit-• ._ rature x i N, #Shing p$ <br /> Name: c, picaX-&'1O Hand Sink: 10U ofChlorine- ck` ppm Heat: `F <br /> Exp.Date: ri JI / W arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By l Title: l Q <br /> EH Specialist: Phone: <br /> Time in: Ci- <br /> . G Time Out: `U• L<- Page <br /> EHD 16-24 (211 pg) 4!3/13 FOOD PROGRAM OIR CONTINUATION <br />