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"aur" SAN JOAQUIN COUI <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orglehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ( nom Date: <br /> Address: 0 lycL �� h City: zip Code: <br /> Owner/Operator: ,tea */" �l a `, Telephone: <br /> Program Element: /d�� v� Program Record: f Y Inspection Type: �A <br /> SB180 Poste Ye �( No Permit Posted Yes No Re-Inspection on or After: <br /> 4S AN CORRECTIVE ACTIONS <br /> �, �... <br /> r <br /> ---- - Lam/ � � �t_ -- -�----------- <br /> N G 'kel <br /> Of <br /> V L�(�tn�vL <br /> v <br /> U .._.._.......-_. <br /> v <br /> IVY <br /> ItemlLocetionemperature - Item/Location emperature <br /> =_ <br /> 4 :�, a1 I acility Hot <br /> emper y Warewashing <br /> Name: G Hand Sink: l Chlorine: PPM Heat• 'F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: I,,' ppm Other: *F <br /> 141�1 71/ <br /> Received By I Title: " <br /> EH Specialist: Phone: <br /> __.._....—..—---- .-_..._ <br /> Time in: ;' r Time Out: , Page f_ <br /> EHD 16-24 (21"pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />