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,oPa •COG SAN JOAQUIN COUI ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.sipov.org/ehd <br /> LIFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Q C G –f �, 14 cc Date: <br /> Address: 0 � City: Zip Code: <br /> Owner/Operator: L Telephone: _ s <br /> Program Element: / Program cord: / �s C, Inspection Type�,� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATlflNS AN©CORRECTIVE AGTIC3NS g -"- <br /> ,a . <br /> .... — ---.._._......-. <br /> v� v i9t � <br /> ivw <br /> o- <br /> Item/Location i Temperature Item/Lpcation z -_!_Temperature <br /> .........-I_AJ --- -- — --..-- -- — <br /> e ,2 V,,, <br /> Food Safety Certification Facility Not Water Temperature Warewashmg <br /> Name: i'Hand Sink: °F Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: PPM Other: F <br /> Received By 1 Title: <br /> 1 <br /> EH Specialist: Phone: <br /> Time in: 1 Time Out: Pagel o <br /> EHD 16.24(2n1 pg)413/13 FOOD PROGRAM OIR CONTINUATION <br />