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oP41'" SAN JOAQUIN COON" <br /> �.•.�.CSG <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4.. ��P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> �1FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,OPN Date: <br /> Address: Q ``cII r L city: ��C!_ �,.\ Zip Code: <br /> E S 1 <br /> Owner/Operator: 0.� �TaR k� h F- Telephone: \ <br /> Program Element: &2 5- Program Record: o)6050_2_ Inspection Type: ��- <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: W Q� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a <br /> 1_ <br /> 2 Tk 0. <br /> ✓^ GJ`- QST _ /i0 W O 1 h <br /> T �,.� r a S G 5/,w o !ae <br /> w t loi' Pr IZAVf <br /> 5th t�� 11a vr5 w2.-e 4u r&te�_ CLt 00'OF <br /> eQdS a Imol d <br /> keAS o�fifer- W cts6u r,l <br /> wA4. I s �'n �1� (s ..0,17� a e <br /> �. a-a sr r•l�, r�� f ci,.,e!_ in-tri, <br /> rtv I k f- k3A r'. <br /> ni+r I e w- S < . <br /> k , r, . Lc7&. <br /> S 7'ka cpr 4cc o ' 4 r A- a,-eq::� ct r'Q_ <br /> r rf7 tc�Etz Z <br /> .� jacj q"k F r �21vi ac r.�g6je-ca&".q4- <br /> o QF-p - rw 4- 4 ('(QE le 1' K Fr C-4of-5 . Pi-c)vi <br /> rt"'Q vk-�rs- 1� q I I r�r-( pr0.{,QrS L S . <br /> Item/Location Temperature Item/Location 7777Tiemperature <br /> Ll OL?c- <br /> ��r c�cP-�' .� 1'F <br /> IGS- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: c� �� n- Hand Sink: / (3 O of Chlorine: ppm Heat: of <br /> Exp. Date: ,�Sl Warewashing Sink: Ouat.Amm.: ppm Other: o f <br /> Received By/Title: <br /> EH Specialist: N Phone: _ 3 Y ;- <br /> Time in: 46 Time Out: Z_ Page Zo <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />