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SAN JOAQUIN COUN� <br /> 4O. .COG <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> �q.. ip Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.orp/ehd <br /> �j ii o. <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 10 1 <br /> Address: ( � City: Zip Code: <br /> Owner/Operator: kit 1 , A ti ,\ Tel hone: G f Cr� <br /> Program Element: I Program Record: I o V I spect Type: ' <br /> SB180 Posted/Yes No Permit Postedes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> " (3 rem a„cl rs o.-.c_I i•E- "..� �r s � r✓� � uc� 'r 5 ��t> R� ,/z <br /> �4e OrS 1 Z 7 - <br /> 2. ke +t"(e S j� 1 o cG�_ <br /> 3 D( �r lncX2s u. 50 c (�c7 a" Gtv. 7Q�c r 11C� �ki c4 <br /> r <br /> e <br /> CuteAA4, W <br /> A f W C ee��► b // <br /> n , 'Cie, a-411g o a7111 <br /> ! c a t .44S <br /> / <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> G 1 ,3 5 2 6 0 r <br /> Food Safety Certification WFacility Hot Water Temperaturerewashin <br /> L ihw'a>l;ira <br /> W- Q: <br /> Name: Hand Sink i 17� of Chlorine: ppm Heat: of <br /> Exp.Date: 5- -Lp r Warewashing Sink: 130 of Quat.Amm.: ppm Other: o f <br /> Received By/Title: <br /> EH Specialist: n <br /> Time in: Time'Out: ` Pag of 3 <br /> EHD 16-24 (2n°pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />