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SAN JOAQUIN COUN <br /> P <br /> ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.si9ov.org/ehd <br /> c;i=aRa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Cj Date: G• <br /> Address: y ii 04 - City: /� C zip Code: <br /> Owner/Operator. Telephone: La r C <br /> Program Element: Program Record: S-2 Inspection Type: ^+ <br /> 8180 Posted ❑Yes ❑ Kermit Posted ❑ s ❑t Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ' r <br /> 0 <br /> e ,/:e .... _ <br /> r�WQ _ r o e - -- <br /> Yl - <br /> Item/Location Temperature ! item I Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature ,', Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: F <br /> Exp.Date: arewag Sin <br /> shink: of Quat.Amm.: ppm Other: of <br /> Received By I Title: J�� <br /> EH Specialist: 7s l Phone: L D3 <br /> Time in: �® Time Out: , Page of <br /> EHD 16-24 (2`pg) 4,13/13 FOOD PROGRAM OIR CONTINUATION <br />