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C" <br />PQu!" SAN JOAOUIN COUP: ,'Y <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />= 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siQov.orq/ehd <br />�/FOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: "�� <br />Date: , <br />Address: � 9 1 u r ,\ <br />•l W <br />/ a n� L� ^` City: i r p C Zip Code: 9 53 7 <br />C� <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: Inspection Type: <br />SB180 Posted es No <br />Permit Posted Yes No Re -Inspection on or After: <br />rt s Irv, Ies Uj Ci r #co- 00 -/Orr <br />al ; :n <br />Vzo I wt. - ✓:d amen e din 1/ <br />o <br />W U >4v ra I'4v r N 4 // Jr. <br />YA-r% <br />hd 4 vi, ler a 4 Ot^ Gby y l,2 OCore ri <br />v dao <br />3 Welk - IA <br />r il n;n 1 A4 � �. 911A - In -t C, j j W a I n <br />A+ V1' be <br />Ccrr c'F 4oc1 <br />4 'T M 1, Id C l e 40 AA <br />S TGQ S Com <br />S-1 On 40 O ryl aCh ne 5 40 re <br />C0 S Cco <br />CleCAC, /e 6 C101 lot r\_0 r. r r 10 Arjc <br />t/Cc <br />A ore Sh Ii 1 L <br />Yi dl p �I a^, �e <br />jyi,2 It C a hsCe "n 4- MCI 4e'.' 4/ i I wee l� <br />CA air\ <br />re pqr,� o^ S• f <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />_ _.. <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: + <br />Hand Sink: _ of <br />Chlorine: Ppm Heat: of <br />Exp. Date: <br />Warewashing Sink: 1 of <br />T <br />Quat. Amm.: ppm Other: of <br />Received By/ Title: <br />EH Specialist: <br />Phone: <br />f7 <br />Time in: ✓ <br />Time Out: Page 2of <br />ag 2of <br />EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />