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693VIN c SAN JOAQUIN COUP <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �.R. ;P• Telephone:(209)468-3420 Fax: (209) 464-0138 Web:www.segov.org/ehd <br /> a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _ _ C Date: I21 <br /> Address: 1 City: (' �" " Zip Code: <br /> L kA <br /> Owner/Operator: (? �``) f"'� �1 Telephone: <br /> Program Element: J CLy Program Record: Q I I, Inspection Type: <br /> SB180 Poste Yes No 1 Permit Posted Yes I�No Re-Inspection on or After: <br /> k <br /> �� " zt. �� �• OBSERVATIONS AND CORRECTIVE ACTIONS <br /> A <br /> ,� vc Ct rL <br /> yrvl <br /> Chiyuke 'W(hem <br /> a(Glhvi v� l�C(� 1 ✓� 'Yl J' )� t lnly� . L'�l!l'tQG( <br /> f <br /> D Ce ✓ r <br /> wdpl� �G� r <br /> ✓IV t- 041Mat <br /> - 3x <br /> -tea vvuya tvkxiCats, _ W <br /> atlt CW em, - 3 <br /> 1 C It S +- Sa Ja /►"C - <br /> 1 S u 1✓1 C I w Y F <br /> Item/Location Temperature Item/Location Temperature <br /> 3- z --y 1-1 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name:Q y la y�j�m Hand Sink. 1 'F Chlorine. ppm Heat: F <br /> Exp. Date: `. GWarewashing Sink: i _' i °F Quat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: ( j.v� Phone: <br /> go Time Out: Pagevf,� <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />