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'gySAN JOAQUIN COU, <br /> p, ........0 <br /> v� •.OG <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orq/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i� Imbue Vw0 1AOvw t Date: �?r2_Q `7) <br /> Address: S 5 L bCTaj O City: s� Zip Code: q v)z.�' <br /> Owner/Operator: n'�Cm 1 C dr�d 6 Telephone: <br /> Program Element: ,� ' Program Record: �U `(QGG Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: SNP <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> osp&e ,(ej cuAmect-V, Meat-- ca G rCwnd 16 - rM G <br /> Ah.2 i 'Cl-t- 1 1()°F U 2 FM W Se' ce -IU e-f- <br /> vu l� rn S <br /> • Nt T C-�r�nclP.� <br /> �► �n nil n use 6-hll u(,e . kee cin <br /> 1 '1 ulbS t TNs`tcu not c w Ov c yrec7t- -n <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hof Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: Ppm Heat: of <br /> Exp. Dat Warewashing Sink: of Ouat.Amm.: Ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: �_ .1 b)_ 3 44 <br /> Time in: Time Out: `I Page3of3 <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />