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SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c .. _. ;P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> gc;FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t �� Date: C r y <br /> Address: j City: Cwt„� C 4 Zip Code: 9S 2 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: 1 "e- <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> ., <br /> © I`�. TiCa141"iAl(+C}C€ R { i: k � 1�5 <br /> COXz_ m <br /> 1,-,- <br /> a 20 F �r <br /> r t . { iS� h k a dP f <br /> bob G k ( 4 Wee 1/ln USF or IPSS . CC G/G <br /> os 4)w Cnl q C 16 �0; pr 0 1, e h d:s <br /> CGr r a 6161 <br /> 5 door iS cl Se if CloS,-n 9 6 CIted ;,I t AP <br /> 6 ! ✓” rG SOG I S l�. <br /> r97CIr <br /> r Se F cc d r e (n;✓� 10 be 13. Cc,r 4 10 <br /> (,SAMA Ow q[ <br /> re ef e.) <br /> Note', ; V 6)31ro C4 remit,} CUS6"ncr cf. <br /> Item/Location I Temperature Item/Location Temperature <br /> . I 1 Y iglu 3 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: V Sink`r I of Chlorine: ppm Heat: of <br /> Exp.Date: Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title•' \ \ <br /> EH Specialist: Phone: `�.�/6 y <br /> Time in: s C Time Out: U Page of <br /> EHD 16-24 (2"d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />