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SAN JOAQUIN COUP <br /> Q` 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.slgov.org/ehd <br /> ��FORt•1 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: bo to t� .) A a Date: LAW 4 <br /> Address: JOU Q . t I a 0�Ck C) City: S .!_ZM Zip Code: <br /> Owner/Operator: rM��0 Qn FTDT)G1SC(j CJT-k(NC1 l Telephone: <br /> Program Element:- Program Record: 1�R G I rl J Inspection Type: ���•i <br /> SB180 Posted Yes No Permit Posted e 1 No "1 Re-Inspection on or After: <br /> �a <br /> s (L WO M <br /> Ml <br /> C r 'baS v rn t fi 610 -1� <br /> USS \3s C+ _'h . <br /> Cbyjvej Can a fZ ; ;ns (' e o a . Only use res+aw-a�+ <br /> Or <br /> cDdi e SDA ak hana-5i K <br /> vp aroA car <br /> densa V.1, to wa)K'''n s°eZe('. e -rzb/cc <br /> obwyeA wened5 0�- In OAf 54 G a f-m P -f Do 5 in con-6,4a W1+11 <br /> 11AS and labels b <br /> b5erVVA AW rnaJsf, ►� rv _�wAAf oisga c&j vitil a5 dr ►'n t a <br /> lteLocation fiemperature Item I location Temperature <br /> W &A A- - M I I K S W K-i1n CWi fr _. <br /> U (5 A <br /> Ijl cj�c CC I'` <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: '1056 goi Hand Sink: ` L L of Chlorine: �y 11 ppm Heat: of <br /> Exp.Date: I C arewashing Sink: 1 7 ('i of Ouat.Amm.: ppm Other: of <br /> �� <br /> Received By/Title: <br /> EH Specialist: hone: (aM_ p f <br /> Time in: 0 , 0 S- Time Out: 1� ;Q fs- D Page- 1 `;1)' <br /> EHD 16-24 (2n1 pg) 4/3/13 1 FOOD PROGRAM OIR CONTINUATION <br />