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°"!" SAN JOAQUIN COUNO <br /> �0. .COG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> Q/ 6Rt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C,U 1tyb Date:' 4 <br /> Address: 2 2 c h cr-� C City: S , t Zip Code: <br /> Owner/Operator: � ) A r' C1V� L cel Telephone: XJ/ <br /> Program Element: +( ' Program Record: C;e:�)o5 1 Inspection Type: CM�1 <br /> 6180 Posted Y 11 Yes ❑ Rermit Posted Yes ❑I Re-Inspection on or After: �- <br /> /111 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> S <br /> Item/Location Temperature i' Item Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature i Warewashing <br /> Name: Hand Sink: of chlorine: ppm Heat. of <br /> Exp. Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title,;: �� <br /> EH Specialist: Phone: t� q, <br /> Time in: la_ />� Time Out: U Page of <br /> EHD 16-24 (2nd pg) 4/3/1'3"1 FOOD PROGRAM OIR CONTINUATION <br />