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pQu�" SAN aJOAQUIN COL Y <br /> z Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s*gov.org/ehd <br /> ��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /�-[ rel <br /> Date: /o _/ <br /> -l3 <br /> Address: D G . G1444 G City: Zip Code: 2--0-2 <br /> Owner/Operator: �r—,a Telephone: 517_75l? <br /> Program Element: !�2 Program Record: 2 x.74).7 0 Inspection Type: A-el-T4;/'t-2_ <br /> SB180 Posted es No Permit Posted Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I -�- L 1. L&A'G c- <br /> -e-e 5.72- O C S Y;P" O L f <br /> �cnrrtyzj 1 , "Yl.o t�r o- r,.e- CAu Ca b C.e . 6 ✓+- ti,4rn <br /> n ✓ vv a . 12e <br /> Yrs r " Y C <br /> Cc i/ <br /> eAC-2. Z S01 W ' z.2r Fro vc -,R- I CY) <br /> SID 5 13 12 D L o LA_+ 0 n St mA- y l' Le . S hc4 L <br /> V1 <br /> r n 5► I d.p- e <br /> 11 n CO n4C�4tie <br /> LY1 K4, +C- k-e-✓1 C4 r rL 4 v o► <br /> N <br /> UYl A <br /> 61g_Nv 1'1=1 Y -�CY� Y r l Y O <br /> �-i _e X_2 e r 4 Y-1 o Y- d -F r� Geb o CQ r 0✓I d <br /> Item/Location Temperature Item/Location Temperature <br /> DL)n G 3Clcc &''oY- r ce- <br /> a 9top- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: e r I _I _ n Hand M. I a oF Chlorine: pp -m Heat: F <br /> -- <br /> Exp.Date: I Warewashin Sink: /.� aF Quat.Amm.: ppm 11 Other: of <br /> Received By/Title: I <br /> EH Specialist: Phone: <br /> Time in: � ./,0"3,0Time Out: I ,r '� Page, e <br /> Y.J _Z <br /> EHD 16-24 (2,,pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />