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o' <br /> SAN JOAQUIN COUNTY <br /> � CSG <br /> Q` tNVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c... a;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r�Ll �r1 Date: 100 Di 14 <br /> Address: `cb�5 4 1 Y� City: b�� n Zip Code: U 5 2 <br /> Owner/Operator: vv 1 Telephone: C) <br /> Program Eleme Program Record: Inspection Type: <br /> SB180 Potted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE.ACTIONS <br /> -) )sAn & sc w t�x s aor� ctS <br /> vI-,e, nlL t& w-U V . <br /> 2 '0'r `�F kkmt t) 4 1 IT CT WICAAJ <br /> SM_ hCft \N0 0-f �� I� - ur <br /> w snm - c. <br /> Hwy 'g I-s Wyo, Mol - wan <br /> kkQ rum+ nod- m Minn n a C fimAT , <br /> P <br /> 4 gun s c - b T-4- cm-CIS, <br /> re M s-\W w p �- . <br /> vet I e(A 1"S M /ohx�eS C <br /> N <br /> Name: _ Hand Sink: OC) of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: ` � of ('uat.Amm.: I I ppm Other: of <br /> Received By/Title: 1 <br /> L <br /> EH Specialist: Phone: <br /> Time in: C1 ;S/, Time Out: 0 - 2 C) J 1 Page2of2 <br /> EHD 16-24 (204 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />