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SAN JOAQUIN COUNT <br /> : � ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: .a <br /> -_ t, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siQov.orq/ehd <br /> LI FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: r <br /> -3 31 1,�7 � cr- L r, . S c h <br /> Owner/Operator: a P r " . L Telephone: <br /> Program Element: Program Record: S nv 06 yO Inspection Type: i; <br /> SB180 Posted L Yes L No Permit Posted L Yes L No Re-Inspection on or After: 1 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> LAI I <br /> S� �- �'✓� C r�ew r.a 1 LdR <br /> 2 T W-C�r` .^ t OT -e-A at. <br /> Z -2 e +cD 0,� 1 e S%-� 12 0 <br /> C7 +C' '.5 S K I l S er,,��` e� c,2 a Jn <br /> r !' A .-� 0 •k- OSI led o u - (4 <br /> f n C b f 41 r ll k>e tc,i-t cl r <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Lk4_ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F hlorine: ppm Heat: °F <br /> Exp.Date: Sink: 't of Quat.Amm.: ppm Other: of <br /> Received By/Title: ` <br /> EH Specialist: L'fPhone: [.f�c _ 11-t2�' HC� q <br /> Time in: Time Out: 3 , ` 5- Page eobf <br /> EHD 16.24 (2nd pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />