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�of4.gAc SAN JOAQUIN COUNTY <br />z� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />6q.,• a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />4FdA�' <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 1' - <br />Date: j1-14 <br />ddress: 2zi'YA0 Lh <br />City: <br />/ <br />Zip Code: <br />wrier/Operator: v y C�/ -ea <br />Telephone: <br />Program Element: tf/ ? Program Record: 7KOSQ <br />r3 " <br />Inspection Type:,,-� <br />* <br />8780 Posted Yes No Permit Posted Yes <br />No <br />Re -Inspection on or After: <br />D CORRECTIVE ACTIONS: <br />&'w wit1k 7 / <br />l' L <br />NAyrold <br />!�',n <br />Vt u � .� <br />! � 2b <br />Y(% �YYt LI.�iG N Gt L <br />I✓ Wky ya U k" 0X <br />m G pYYI�H� ✓✓ <br />��- <br />f reNm <br />j1Ah&1kt'e_13 <br />..... re <br />WUe <br />care /,1 <br />W I-Aek <br />3IPP <br />o_d__Sefety, ;. -:Hot <br />Name: and Sink: <br />-e / /t r'I l <br />Water' Temperature <br />-F Chlorine: <br />Ppm eat: <br />of <br />Exp. Date: arewashing Sink: <br />of Puat. Amm.c <br />PPM her: <br />of <br />Received By/ Title: <br />EH Specialist: f <br />Phone: <br />GI _- ,_� .(1 _ <br />UIX <br />Time in: 1 <br />Time Out: <br />Page f <br />EHD 1624 (2m pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />