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SAN JOAQUIN COU. <br /> .Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.si4ov.org/ehd <br /> �IFOFt ii <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: DO r '-p- Date: g�� <br /> Address: 2-65 Mc)ri 4,e <br /> 1 .. I>i cu 6 l i u City: G '" Zip Code: <br /> Owner/Operator: )-I ' i u r Telephone: 146-3- 3 <br /> b-3— 3't 6 l <br /> !?� <br /> Program Element: i Program Record: P D bOO ` Inspection Type: a v` <br /> I � <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS ANp CORRECTIVE ACTIONS <br /> -� Ae.-r o A h e -e,vi b + L CPof Lt <br /> m + oLU . mt_ 1 W <br /> a n cA <br /> 1'lkLw l <br /> Yt-0- te,s Ski -S r-e .e ro v4 <br /> $"t rA- ooY C-t-iLi La <br /> r-e of U Car b a <br /> r ic� ca cvt b o "� b <br /> &V-0 re i -ii c. a_ o r Ln ; In, LaL "c. <br /> 6l.n <br /> Item/Location __'__Temperature item 1 Location Temperature <br /> Food Safety Certification (Facility Hot Water Temperature Warewashing <br /> -- I _ _ -11111---.-. _ _,_ <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: l� of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: _ , <br /> Time in: /d .o �'W7 Time Out: 0'. 3 © Pagv -x <br /> EHD 16-24 (2nd pg) 4/3/13 10-',36 <br /> FOOD PROGRAM OR CONTINUATION <br />