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SAN JOAQUIN COL e <br /> `+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c°�/FiiR ;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Cz/L Date: <br /> Address: 53OR Ct U L AV-e- City: 1 5 7410C/` Jr Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: n� D52�� Inspection Type: / n <br /> '� Wt1 , <br /> SB180 Posted t) No Permit Posted Yes) No Re-Inspection on or After: � (�e I ' <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r <br /> - o <br /> e <br /> L L YL® <br /> u <br /> Y - <br /> �f-� <br /> LL <br /> rr 4�6 Ve rr <br /> f <br /> r raL v <br /> alel <br /> u"cle r r Hca- <br /> h <br /> Item/Location Temperature Item/Location Te-nperature <br /> 6�r --- 15 y <br /> rt,i o <br /> Food Safety Certification Facility Hot Water Temperature Warewashing , <br /> Name: Hand Sink: a aF Chlorine. /00 <br /> Qd Ppm Heat: of <br /> Exp.Date: -3 arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: { Phone: <br /> Time in: Ors ` Time Out: / Page of 2 <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />