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Pq"'" SAN JOAQUIN COUN , i <br /> '+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sipov.org/ehd <br /> ,FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Z Z 1 , V r• Date: 7S7/ <br /> Address: �1 " '/�� ;j City: �- Zip Code: (} <br /> Lv r ( 7 <br /> Owner/Operator: JTelephone: <br /> Program Element: Program Record: Inspection Type: Ail <br /> SB180 Posted ! Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> rKP <br /> Cr n i Uj ly e CS. -- <br /> 3 I d <br /> Ir <br /> Cr i G h u1 r, h,, <br /> Rlz u � ,� W re e5. <br /> Item/Location emperature Item I Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature w;� e- Warewashing <br /> Name: �' ` Hand Sink:� of Chlorine: ppm Heat: of_ _ _ <br /> Exp.Date: Z arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: / fi, 3 /V <br /> Time in: ./ Time Out: G 0 Pages of <br /> EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />