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SAN JOAQUIN COUN' <br /> 1 o'-f-,C1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ►��o` <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i Date: <br /> Address: . Z L �p _ City: Zip Code: of S3 J <br /> Owner/Operator: 1 ck Telephone: 2 b� <br /> Program Element: �12� Program Record: 1l^ I Inspection Type:, <br /> 6180 Posted �J ❑Yes ❑ Rermit Posted v ❑Yes ❑I Re-Inspection on or After: <br /> r; ge � s h OBSERVATIONS AND CORRECTIVEAC TIONS <br /> � <br /> S 1Ire - 1 (` L ��^ , -�(v <br /> S <br /> •� u ra.,fJ A Fes: <br /> 2 7 S--\-r <br /> SAY', aLchi r—'�- <br /> 3 � '`;, <br /> — <br /> -�-0 1 e c <br /> c � <br /> n e vet �- <br /> `' perature Item!Location Temperature <br /> \ CQ So 1= \ CAa,_�r-A w O <br /> \\00E <br /> - 9 -- <br /> / o 3t e y &e Warewashing <br /> � <br /> . , <br /> 7Exp.Date: <br /> Han Si c k2S _.. <br /> F Chlorine: ppm Heat: _ of <br /> Warewashing Sink: -2-2� of Quat.Amm.: ppm (Other: of <br /> Received By/Title: <br /> EH Specialist: 1 - t^ Phone: <br /> Time in: + ` Time Out: `� c, Page i of I <br /> EHD 16-24 (2ndpg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />