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SAN .JOAQUIN COU, t <br /> 'p•�G.coc <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> - - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ...- ..a;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �tpOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: _�J! <br /> Address: y1 <br /> O Q City: Zip Code: 5�Q <br /> Owner/Operator: Telephone: '162--,o 6 g� <br /> Program Element: j(,.0 Program Reco C& O, Inspection Type: + <br /> S131 80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> C)BSERVAT{©NS°�1ND C(C3Rf3ECTIVE�AG11 }I�1S <br /> mp>� �nfy o� ls es,_- <br /> -- ,o►yt t„ _4tJ_ _ a,----�b✓�1R'Ch ache, , (moi v 1 j ► '0+ i v2 d —s <br /> iL) _.-__ .�. --.....a�'1-2 _` r - ..9 r -- -- n-5y rrc eal , -1 e <br /> C 'tA_. 5-e....._..{vGl._.............1��O. �'►'� +u .�� -uk n -i S �'►+ . <br /> - -- ....................._..----- <br /> o K e jv oxxt k.c Ij a.�Jc�r� -cs _ tom-,- - . <br /> hq VIC, <br /> w o u 0 -4- to w-tj s <br /> u Cp r vy-� _ <br /> ro I I s l . + ► u. IAP- 'Prav-4cL <br /> oto- at4 4i .... .._ _r_r-e _ . <br /> _►' ey..�L-rz ._'�`-E-i _►'. -- -[s_ ............1-0-01 4M -- <br /> Lo <br /> P�5 ��d Li 11= C.c�+ c� -+-ry i-� 'f F <br /> 12 i Le.... I LAcf t4o+-/500 ►� So v 15 8 i= 'c,Ke*I '5a39 r <br /> Ll M,5---- oF --------�-- b .+ . °F ,,,tom It-,9�' <br /> °.: .. IterisiLocatton a .ia. <br /> 4 impure hent l.t.ocatwn _ Temperatur <br /> erate <br /> wow-J-sa r <br /> K-+ +c J,.t " ill Ifir_e w�-n � ccfC�# –Y <br /> door v e, KA +<J-4-,1 D F ra Lt)n `� _ LlOt- <br /> cLoor coo Le r 1 • 8 F Friea 's 8 tl � <br /> mg <br /> Fooilafety+Gertificonac �tyHotVVa�eremperature VVrewashEw .. <br /> Name: Hand Sink: 12 IF rine: r r -7A0 ppm Heat: -F <br /> Exp.Date: are -hi g in ' of O ✓ ppm Other: of <br /> rn <br /> Received By/Title: <br /> EH Specialist: Phone: 5 3 -- '0'1! <br /> Time in: O Time Out: P-11; Page of <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />