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0 SAN JOAQUIN COUNT01 <br /> r " ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> cq.. `,��p• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sioov.orcli <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: k-d „ . I li ob .r r _I U Date: �__ S _/21 <br /> Address: I ZC) f 11 I D city: -fir ! Zip Code: ` <br /> Owner/Operator: _T CA y :5 1C ' Frp& (. L C Telephone: 8,35, 400o <br /> Program Element: 6 U Program Record: S iD 00/ �r Inspection Type:co <br /> �4c , <br /> SB180 Posted - Yes 'I No Permit Posted Yes E No I!� b Re-Inspection on or After: <br /> OBSERVA <br /> Irovi 2 /Gcold V) a )tr K n oh A ar a a 4 <br /> O r { G <br /> ►c : Una priiifl Able MA',nJ .-+.1 a } ar <br /> b <br /> )o 'j 4 l o r C, r a b ve 1 3 S ' <br /> e arri c d. <br /> Item/Location ! Temperature Item/Locatkii Temperature Item/location -..Temperature <br /> (,�.. I F' .1J, lhlP rJ Y I” ..SOC. . �. <br /> j r U; lI- oor ilv r- <br /> Food Safety Certification Facility Hot Water Temperature <br /> Name: i C7 11 Hand Sink: %6L, 'F Chlorine: ppm eat: "F <br /> Exp.Date: -2 <br /> arewashing Sink: 2 'F Oust.Amm.: ppm Other: "F <br /> Received By/Title: <br /> EH Specialist: IP one: 8', //f7�' <br /> Time in: V. G Time Out: Page/of <br /> FHD 16-24 (2-1 1/18/12 0 FOOD PROGRAM OIR CONTINUATION <br />