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SAN JOAQuw Cour._ I <br /> 4' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ... . ;P• Telephone:{209) 468-3420 Fax:(209)464-0138 Web:www.siQov.orq/ehd <br /> 4C1a=oa`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Su b Date: j,,J.< -)r <br /> Address: City: Zip Code: 95330 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type:xGa „c <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONSAND CORRECTIVE ACT1t7N•, <br /> .. ... nom....-----...----- <br /> q- a p.s-...._i in 10 y" Ca rr.n Cul �p[ c+ n i n c h <br /> 0 fu#1et 1. cerre cl in t 1A)eeleo1 / <br /> (� G h hoot. !. <br /> / <br /> - W 1 Cot ;hC j U 01 !/ S O <br /> IIV. dna vrlC l u <br /> tGtiex o er- C lr1 : !',• c - I <br /> I` L r l10 y <br /> o <br /> Item/Location Temperature Item 7 Location Temperature <br /> -- ......... — ..... - -- - <br /> >f- <br /> -- - -------- ---- <br /> ry lin( t-/l 1, S 1,10 1cahl( <br /> a �U <br /> Food Safety Certification -E Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: � <br /> Chlorine: Heat: <br /> �-�- F PPM 'F <br /> Exp.Date: Warewashing Sink: I 'F Quat.Amm.: PPM Other: `F <br /> Received By/Title: <br /> EH Specialist: - Phone: <br /> _ 4 6 e 316 <br /> Time in: ' ,3 Time Out: U b Page of <br /> 2 <br /> END 16-24 (2nd pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />