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SAN JOAQUIN COUN <br /> 0 <br /> z-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.. - iP Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> 4VFORi•� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ke v-,.) L he Date: <br /> Address: 23b City: W Al� Zip Code: 01 <br /> Owner/Operator: P� C Q- Telephone: 3 <br /> Program Element: ` Program Record: c J 3�.� Inspection Type: 2 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 2 <br /> (J\v <br /> 2-1 <br /> C A, a S Z <br /> - <br /> "Te e c -e - <br /> S An l '\,6A <br /> 2�.Je2 <br /> C J. <br /> Item/Location Temperature Item/Location <br /> �97emperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: W arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title. I <br /> EH Specialist: Phone: �4 bra _0 <br /> Time in: ,`•u 2 Time Out: i z , Page of <br /> EHD 16-24 (2'd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />