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oP41'" SAN JOAQUIN COUP <br /> 9� .e.foo <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �q.. �;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.se-ov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t�un'� S i�- k <br /> Date: ZS I <br /> Address: 1 Q 4 S ic- i 00(-600 ;1 City: <br /> GAVv N_� Zip Code: q <br /> Owner/Operator: .reuzof) anVIc Telephone: 7 _ Z4� <br /> Ib 2U q- <br /> Program Element: 102. 4 Program ecord: tou Inspection Type: <br /> SB180 Posted Vffes No Permit Posted Vles No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS040 W <br /> sce ria (Arc -n . Clean oon ccs <br /> U� <br /> scm n s-d-e lhz -4, Lmarhm _ Own Azmy <br /> sUni - buC -er <�o CA—Am r'k- _ <br /> �F�od nd qr�S � s%te <br /> Item/Location Temperature, Item(Location Temperature <br /> _ .......... <br /> - -- — <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: O!SA UHand Sink: 100 of Chlorine: ppm Heat: of <br /> Exp.Date: t 3 I G arewashing Sink: z of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: �� <br /> Time in: U : — Time Out: �1 Page2of <br /> EHD 16-24 (2^a pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />