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POLI" SAN JOAQUIN COUN� <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. ;P Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> 94:j <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: on <br /> Date: r� <br /> Address: 33 ' Or <54 . City: �O c.K n Zip Code: <br /> Owner/Operator: r ip YXA' Telephone: <br /> Program Element: t(0 t5 Program Record: f�_o ((0 I y Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> YL _ 04�tYrrzcl rl Ypu-c; L-(� CA-,e Q r)'7 e22r' . <br /> 1,e ,� .. <br /> VV � T ~ <br /> n 1 b v <br /> Item/Location Temperature Item/Location Temperature <br /> 3 <br /> Food Safety Certification Facility Hot WaterTemperature Warewashing <br /> Name: Sink: �F Chlorine: ppm Heat: OF <br /> Exp.Date: War0ashin Sin 1Zj of auat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: 144 r_ Phone: i <br /> Time in: r, T 153 <br /> Time Out: .� Pag of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />