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SAN JOAQUIN COUN - <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.. • .�;;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.si4ov.orq/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: )jl LC'v� S C City' La a h rc,12 zip Code: 9 5 3 3 0 <br /> Owner/Operator: p 0 Telephone: <br /> Ari• I 1N <br /> Program Element: ,1 2 S Program Record: �' Inspection Type: <br /> 6180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑ . Re-Inspection on or After: <br /> CBSI RVATIONS AND CORRECTIVE ACTIONS <br /> t � F-CA3 CG roc r-t' <br /> 141 <br /> Z Spn � �;Zer � 0Cke � Q4 fe'S3 f'ha n 10.0,14", 4•ugf. <br /> Co +re cfo d. <br /> U i I • 4 Or) C le ' 'A fv0 a <br /> Ce On Cc n Je nS P r rt A I ee zer, e/or "C <br /> Item/Location Temperature Item/Location Temperature <br /> ---- - -- <br /> Food Safety Certification Facility Hot-Water Temperature Warewashing <br /> Name: Hand Sink: of !Chlorine: ppm 11 Heat.. of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ~ ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: y <br /> Time in: I Time Out: �O. Page of <br /> EHD 16-24(21"pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />