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SAN JOAOUIN COUN . I <br /> W X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si-gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: CA 7 Pe' n S Date: <br /> Address: I v 3 U W 11, 5 J City: r G Zip Code: 3 J <br /> Owner/Operators: Telephone: <br /> Program Element: Program Record: Inspection Type: UN ►�C <br /> SB180 Posted i Yes Ll No Permit Posted Yes No Re-Inspection on or After: <br /> n OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 3. do r YI r X311 M - 1 1' C-I-$ JAGS <br /> 3 G. 11 t(Ai �G51 . ns ecj,ourecry Gn l�. <br /> Item/Location Temperature Item!Location Temperature Item/Location Temperature <br /> 0 4"-13, Ij.( 3" LlI jV)C,64e _ (3. 1� � a. yI/'/- <br /> Food Safety Certification - FWa2"..h..q <br /> acility Hot Water Temperature Warewashing _ <br /> Name: n 1 / Sink: of Chlorine: PPM Heat: of <br /> �V <br /> Exp.Date: Sink: !� of Ouat.Amm.: ppm Other: of <br /> Received By/Title: ti , _ <br /> EH Specialist: Phone: <br /> Time in: 1; Time Out: I v.�U Page of! <br /> EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />