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SAN JOAQUIN CO <br /> u,Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . r... :P. Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 4c;FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: _3 <br /> Address: City: "� Zip Code: <br /> (.L� �7rGf n-I 1 q <br /> Wl D <br /> Owner/Operator: 614 Telephone: �J S�_ 5`7 2 <br /> Program Element: 1,0/9Program Record: 0a 0 5 0 3 -, J Inspection Type: O?� <br /> SB180 Posted Yes F1No Permit Posted Yes ❑ No �O Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 67r-D _ <br /> v v. "r <br /> r _ .- - rLA SDI Q LJ <br /> k0 � <br /> D c9 -1 �JpF — <br /> s -3 <br /> >�rLe4-s 3 qT 6X_C�0f( 9 1 OF <br /> YYt ° 1i11 ' k"'rzAct 310C <br /> 1901M j- +5 °r <br /> 2Pz +-r-0 rr7-s ha v'-L CL.,; r Cej r�-+✓t..�' <br /> Item/Location Temperature Item/Location I Temperature <br /> 2o-fiseri`c­) Iy3°F 11%� b S _- 1 F <br /> 0 LA 8 5 &Sakv 3q +- Up <br /> -ryu&l Ll <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> =-- ----- -....- ------------- - - ................ ....--- -- <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Wa ewashing Sink: `mss of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: i�� Phone: S� - -7 8�7 <br /> Time in: Z Time Out: f/'q'5 Page of <br /> EHD 16-24 (2n°pg) 4/3/13 T FOOD PROGRAM OIR CONTINUATION <br />