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pP4�!N c SANJOAQUIN COUftr <br /> �.•�••.oma T <br /> y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> -.-_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..• ��P Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: +G11�1� , V ' t Gn GI Date: !j/ V I . <br /> Address: 2 30 �-� City: (IL�Fni Zip Code: ��G <br /> Owner/Operator: `f,� \ n Mon ��l Telephone: q <br /> Program Element: �2 Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted (Yes) No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1i 'Pte .eil & r a . 19Iwo 61) w - <br /> Scu C' c r,e i n r42�_+ tZ,'da <br /> n fire- Paod T•eQ . <br /> 3S I-h i� (San i ii U _' S O t , . <br /> 11 <br /> �-NI CV Ck �QI - CIQSi �,(.e PS M C�GC�r arO <br /> ioo r 0--Yu . <br /> rpt nn ����QQ �/} r� 1 C /� p <br /> P-N ide 1 SUV\ 1� J I' , GS I In <br /> 'J O a <br /> cu VNSp0nod 01-� 6 C kAcAJIn irl ot <br /> CCAt CD t MaS <br /> 3 r <br /> Oq< <br /> F�acitit}rHbt gterlcmp�tatur2 �' <br /> Name: I. u p fy <br /> Hand Sink: 1 ()& of Chlorine: _Yv ppm Heat: of <br /> Exp.Date: Q % l Warewashing Sink: C Z j of Ouat.Amm.: ppm Other: of <br /> Received By/Title: Yom. <br /> EH Specialist: Phone: 54 fo <br /> Time in: i . I Time Out: G, Pagizof Z <br /> EHD 16-24 (2nd pg) 4/3/13 -/ FOOD PROGRAM OIR CONTINUATION <br />