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SAN JOAQUIN CAN <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • r... ;o• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sogov.org/ehd <br /> 4CIFOR� J'� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: rs t„td(l[Q Date: 2ito IfI} <br /> Address: 2�7 W j,� �v City: S.,-D _VV_1 Zip Code: 202 <br /> Owner/Operator: /'n O Telephone: (p _3b <br /> Program Element: I Program Record: �i Inspection Type: V ISI' <br /> 8180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �m�i G n gees h heeo <br /> FCA <br /> i <br /> A n �1 <br /> CA t 11 <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: �F <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: V" l ,ek <br /> EH Specialist: Phone: r1 W <br /> time in: I Z),I LA i Time Out: kc-.) Pagel of I <br /> EHD 1G24 (2n°pg) 4/y13 FOOD PROGRAM OIR CONTINUATION <br />