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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.sigov.orq/ehd <br /> 9Cj PORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: .� L. u c r Date: 5 .� <br /> Address: ' City: rL Zip Code: pS3�b <br /> Owner/Operator: J Telephone: / <br /> Program Element: Program Record: Inspection Type: �ON <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Ca I, G ); ►� � n idn AIr h ROM a✓e. <br /> rd bc <br /> Prov ; de s, - S0121 a Por (pump SI <br /> C� u <br /> Item/Location Temperature Item!Location Temperature <br /> -- - --.... - -.._._..—------ ——--- -- - -- -- ----- --- <br /> - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Ha"Sink: �j � °F Chlorine: ppm Heat: 'F <br /> f14 f2es <br /> Exp.Date: Warew k: °F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> I <br /> EH Specialist: Phone: 4/G 3 I ZO <br /> Time in: �v Time Out: Page of Z <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />