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SAN JOAQUIN COUN i Y <br /> 2-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq.. ;P• Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> ��FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C ' i, �� r Date: <br /> Address: li> City: TY-A r Zip Code: <br /> Owner/Operator: Telephone: 22 h(-2 (7 <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> '0 SOniJiZrr h ��c Kf Fs (' { I0 J S-00 0 ryl nfor i e, <br /> Gurrrc It J. <br /> 1 fa il; a I (AC kj 4;ter air's -1 Sir , S Pr vi /o_ in �2 Q s <br /> S Proj/ )e 11un j S : s yr tf51rGv C c r i c 4- <br /> to e, <br /> f'toed W. <br /> y CA W WOO11 } rcn {' n Oar r\ Prd.s Ja b t <br /> e d or le r r e t <br /> s ►us h,A n I W nsA y 1 61 12 3 A Ion eS r N <br /> (, P re n k ho or r (4 nn; r u a // ri <br /> U f W40r-4POr/ , {' <br /> e j CGryec <br /> T <br /> 7 C0 stood S �OrrP Irk 1r [ . Cerroc4e <br /> 3 Uq C C I CA C S � ilYIQ CC � rc. S4iCWer, b ;s Cc r P <br /> v 0 (JA / � i n t O n � h� our. ('C r r P c I e e/ <br /> 1� <br /> C' 'C I1c+ nv4 S . n1G 5 arbC C an5rrc{cool <br /> yjC"Iy�'F „Z- door 0ev-a- r (2-d0 . - �I F <br /> Item/Location "" I Temperature Item 1 Location Temperature <br /> - ._.. .... -..._._—.._......._ ..._._.. -- — - -—.. ." -- — ---. .......... --......... <br /> �s )4,1 uc, l )_� <br /> h C V - G iIr l ' d 0or) I J'G <br /> Food Safety Certification Facility Hot Water Temperature <: r o Warewashing <br /> Name: a ec, )6 Hand Sink: )C ( of Chlorine: ppm Heat: of <br /> r iGn <br /> Exp.Date: C arewashing Sink: LJ of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: one: <br /> Time in: 9. Time Out: I 0 y� Page of <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM DIP CONTINUATION <br />