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SAN JOAQUIN COUN' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siQov.orp/ehd <br /> �iFoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C( re_+bf Date: ( -ZL{^� <br /> Address: 3 �S fpr City: G +� Zip Code: 2C7� <br /> Owner/Operator. 1 M 1 Telephone: <br /> Program Element: (02(7 Program Record: Z� Inspection Type: c� f <br /> SB180 Posted Yes No Permit Posted�Yes No ( Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �ql cy(� <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: I / C of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: �J <br /> EH Specialist: ' Phone- <br /> ime in: 2—;S 0 Time Out: O Page>ofZ <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM 01R CONTINUATION <br />