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SAN JOAOUIN COUt <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> L�FO•Ra <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: GrIGCity: Zip Code: <br /> �1 <br /> Owner/Operator: r. 4 CA <br /> r Telephone: <br /> LA Y � / s <br /> Program Element: i G C ( <br /> Program Record: S p oc � 1 Inspection Type: <br /> R �v <br /> SB180 Posted Yes _1 No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> c� r 1201 �— 1 4.v G/ <br /> �; <br /> 2 0r 'J r 14 A <br /> O t l r - j , n e K's <br /> y 3 o -- <br /> U. a jo e. /Y7. ✓1 C C vl. <br /> n 0 IF14 0 •rte, <br /> 3 Cv✓Yl � � P� �1 �c� v✓+ 1?� [� � U r�� jrc <br /> � yy <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: OChlorine: Heat: <br /> r ��.�' k�.'(,1 r F ppm OF <br /> Exp. Date: Warewashing Sink: of Ouat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: - Phone: <br /> Time in: , Time Out: Page, of <br /> r <br /> EHD 16-24 (2o1 pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />