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,oPa .�oG SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si4ov.orq/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C n Q hi.�( Date: V Z 4 <br /> Address: �r-, �-� 1l City: �}�yy Fig Zip Code: <br /> Owner/Operator: lu �u S "06 (-- u t Telephone:4i7 }s <br /> ^25 <br /> Program Element: '�.Z Program Record: M 0 1 -� bbo Inspection Type: �•t <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> v C) L-ACIMS C C.,Yyg CAO Q CQ <br /> o r) &CAUbyef �&j CcTyTeG*d <br /> CM0 91i 01 GO s in T(10 tC*" _ <br /> CCAd -b 1 S <br /> Item/Location I Temperature Item/Location Temperature <br /> —� �..—..._._...-._._.. �..---- ........ ------ ----- .....-- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Title: <br /> EH Specialist: > Phone: _ <br /> Time in: Time Out: Pag of <br /> EHD 16-24 (2n1 pg) 4/3/13 �/ FOOD PROGRAM OIR CONTINUATION <br />