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SAN aJOAOUIN COUP <br /> .Za 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 /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �L,�-� UU, Date: 2/5Z <br /> Address: 1-+50'+ m/•t R: O-c-CACity: stv_ Asn Zip Code: p G� <br /> Owner/Operator: C u-S�J-e Io CAu `�l'�1 Telephone: cc,, <br /> Program Element: Program Record: Inspection Type: V <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ------ ...........- -- <br /> � <br /> CA <br /> Item I Location Tem erature <br /> iten�lLocafion ,.� Temperature �— � , l?_ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm (Heat: 'F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: �F <br /> Received By I Title: <br /> EH Specialist: - Phone: (I,G' - "- <br /> Time <br /> - Q <br /> ime in: �� �� Time Out: Page Jof I <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />