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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.sigov.org/ehd <br /> L/FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 r� ', .� Date: /1 / ►/ <br /> Address: Ii 0 <br /> h City: Tr 41 C Y Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERI/A?i{�NS AND CORFiECTtVE ACT1©NS <br /> 'alpp __ _ ; .� locr S , nK IBJ. Fh bur lq �� u <br /> �n_C.__ oy t_T. r&Lj :)[� u r pr r l e xi✓l Elf U G r S. r► K G ii-Iq - <br /> ar1� f[ .r 1�__._._. ,��ti��C.. } 1 a n r n✓r►a v ------Cl h t ,,- <br /> Aa r�a 1 4c,da 11 <br /> i <br /> Open � Gr- C Pn volk SN - , <br /> Qtrect 4 a <br /> G i.v' G S h d is ho G h C;/ Sm n1;2 W C4 4('r Ar C n 6- <br /> G h I or; n A I Liu o Vi U51 U)C' M C100•f Ur mv.-e 1 I scGov <br /> cl or r; els e Ci f% h A,,, Cccr oc A-ad. <br /> r v;de � _�_. co Ir -Po", A.n"l/f r Co ,/ <br /> rr) r proll:ldpghd Soy; Gn �MR tieupl5 <br /> t�n� <br /> S • <br /> 1i S C >1 ; 4 S a -3 2- W At; K <br /> ns IGtHe Se ver., 1c,c,, .4 it, rLs 7h 7 Ode an cov. n G,/" l <br /> ; /s-, are h rJ ' V ✓ "i O cef 41'4 e a V <br /> ratu <br /> empTere ". Item 1 Location Temperature <br /> Item/Location - �- --u--� - _ --- — <br /> ........... <br /> I I <br /> I <br /> _............. <br /> Food Safety Certification Facility Hot Water Temperature �Warewashmg <br /> Name: Hand Sink: of Chlorine: ppm Heat:i F <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: - Phone: <br /> _ <br /> Time in: Time Out: Page, of <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />