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SAN JOAQUIN COL' 'Y <br /> �o <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.segov.org/ehd <br /> �/PpRN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: "O --s Date: 1,0_/)- / <br /> Address: -, ` [t 1 _t,.t.-f rr-w- r � City: 5+d GKton Zip Code: 5 !O <br /> Owner/Operator: 51 /� tel Telephone: W73- <br /> R 7 <br /> Program Element: Program Record: P GLO 5 01 a I ti Inspection Type: V h <br /> SB180 Posted )k Yes No Permit Posted Yes "o Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> i t <br /> op 5►' - 1 An�il�s 110+ LIJ a-4-e r- <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing Crib CO tlx <br /> Name: d Sink: mS J, of Chlorine: ppm at: of <br /> Exp. Date: O Sink: h uat.Amm.: ppm Other: of <br /> Received By/Title: yK <br /> EH Specialist: , I„ Phone: <br /> Time in: 1 �► �l Time Out: t i a�D Page,,,of <br /> EHD 16-24 (21,1 pg) 4/3/13 6 FOOD PROGRAM OIR CONTINUATION <br />