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SAN JOAOUIN COL Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.. � , iP Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> gc;FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: d Date: Q- 1 - •z� <br /> Address: .1 t IJ �e I o rcz.,:�to City: O -b r7 Zip Code: 0Y5,-;'-0-.x <br /> Owner/Operator: , t _ r -e- n Telephone: e4&-5- S,Za _-2 <br /> Program Element: Program Record: 5a I Inspection Type: <br /> SB180 Posted 7CYes No Permit Posted /(Yes F, No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r S ` CFQ <br /> Item/Location Temperature Item/Location Temperature <br /> r f6oA pluo 33O - <br /> ekit4on 16 a-t _ <br /> /10 rri clO OF <br /> �o > - -- 13q <br /> or <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of [Ch�i��. Ppm ,Heat: of <br /> Exp.Date: Warewashing Sink: F at. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> /7 <br /> Time in: 61 • 16 Time Out: f Page of <br /> EHD 16-24 (2°pg) 4/3/13 7 FOOD PROGRAM OIR CONTINUATION <br />