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4"'" SAN JOAQUIN COUNO <br /> '° .0 <br /> 2+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . ... - <P• Telephone:(209) 468-3420 Fax:(209) 464 38 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: U i f f �� r } Date: y-I <br /> Address: ) 9, <br /> ^ f i h 4,h � City: S. x 11 Zip Code: r .2GC <br /> Owner/Operator: CC_ /u Telephone: (�s <br /> Program Element: Z Program Record: U y / Inspection Type: <br /> SB180 Posted Yes ❑ No Permit Posted Yes -' No Re-Inspection on or After: <br /> OBSERVATIONS AND VE VE ACTIONS <br /> Gla lions <br /> Ccrreocteif eYcP �' <br /> t ac; hoc cl, McI/e G nd <br /> 0 I Idse hocdjoy�ri t r , +o <br /> r, d IMA vJ l r <br /> Cs <br /> Item/Location Temperature Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm 11 Other: of <br /> Received By/Title: oe ' ' <br /> EH Specialist: Phone: p^ <br /> ,7 `Y/46 <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2m pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />