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PQu�k SAN JOAQUIN COUI <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ..JF . ;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'-ov.org/ehd <br /> � O'Re� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t , •A 2,o2tj Date: (z) �y <br /> Address: 11010w��i {� L City: Zip Code: <br /> Owner/Operator: \\�CLI � V � i!`CC Telephone: <br /> Program Element: W Go Program Record: O pb t- Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No 7 Re-Inspection on or After: I <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 90ky a.0f_ 1DQthCA1%h A61'\-A6A(e- (,61� 105ldr- -f)v- s-i(k_ <br /> vr� t 5 a rv�(1t� ++ a��vw��► p av► aYV-- <br /> Item/Locat!on Temperature Item f Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Dat Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: Ca_ <br /> EH Specialist: 4 l `=j _ Phone: ��y. A", <br /> Time in: }2 �` Time Out: +;�d Page of <br /> EHD 16-24 (2n°pg) 4/3/13 , J FOOD PROGRAM OIR CONTINUATION <br />