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SAN JOAQUIN COUN' . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c... �P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s4gov.org/ehd <br /> 4L%FORe+ <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - Date: y <br /> -oS�r� 5 C!� d zC <br /> Address: 2 Crcilj <br /> L City: TI-U Zip Code: c)5 J 1 <br /> Owner/Operator: — / Telephone: <br /> S C U v 'L <br /> Program Element: Program Record: �0 I Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> C Cr <br /> qr T4 r h D C4r11 i „ � qr- G; a a � <br /> Or be IG vy czl j rn U TIF G � q,;-t e Cc <br /> Item/Location Temperature Item/Location I Temperature <br /> -r(1r o-qi "c <br /> -- -- <br /> ---------- ........ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: nF <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: U Phone: <br /> b <br /> Time in: l� Time Out: I 33 t; Page/of <br /> EHD 18.24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />