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SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .. ;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> 9CIFORt'• <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,? ; Date: / 21 _ , <br /> Address: City: Zip Code: <br /> 9S_77i <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 /> T ` / OBSERVATIONS AND CORRECTIVE ACTIONS ` <br /> pfmovc i cc -o dq <br /> u;I d-uI2 U n dy r 3 ke I ye3 WC, IA. C/4.rn tGG�.1 <br /> 3 To: 1t P a ars Jjde,njer 1 01 <br /> U I as fro ,�n l <br /> 4 -14 C4; Y1 I G54 -n .1 PC ji Oil Oil 1e. <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: l Hand Sink: jL ` of Chlorine: ppm Heat: of <br /> (G , <br /> Exp.Date: U ' arewashing Sink: � f of Ouat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: — Phone: <br /> U6 Y'- 3 1,6r <br /> Time in: 0 <br /> Q. 6 Time Out: I n.3� Pag5of <br /> EHD 16-24 (2nd pg) 4/3/13 ' FOOD PROGRAM OIR CONTINUATION <br />