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" M SAN JOAQUIN COU <br /> •,AG <br /> 4 2a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ITCL ` tIV-1 rt J C> Date: _!a-IS <br /> Address: ' O �� �,� A , ,� lCity: Zip Code: Fy <br /> Owner/Operator: r`�' Telephone: <br /> Program Element: z` Program Record: P IJ I to l) L• Inspection Type:i W1 �; ✓� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> (O <br /> 47 <br /> ` Q13 ERVATIONS AND CORRECTIVE ACTtDNS <br /> - "� -� e� %�S i'? <br /> C�•oo r >�-T'Yl�L r� W c. � �-_.....�.C�a n <br /> ---- U_ _f+>2 >1 --- <br /> ...-_..... ►'\—�-�'� ----— -e-�' '.�-� <br /> • rZ� d '; n r-Y-e-rr- CA,Y- iiC.e_ C,)'1. A._-4_ _�t <br /> v rri tb vi-PA rPLa <br /> - <br /> big r r <br /> ItemlLacation v. Tstiipeiature :' 1tem,l.Location 7ert perature <br /> Foptl,5afety Cert�ficat'idn Y y Facli#y Hq#Water.Temperature Warewashing <br /> w <br /> .. <br /> Name: Hand Sink: of Chlorine: Ppm 'Heat: of <br /> Exp.Date: Warewashing Sink: -F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: _ Phone: <br /> Time in: Time Out: i 0.,4io <br /> Page of <br /> -73 <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />