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SAN JOAOUIN COL' 'Y <br /> r ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:{209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.or_ /q ehd <br /> LtFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: :` Date: <br /> Address: C �ryCity: Zip Code: <br /> Owner/Operator: aLlnc4!� L y- R Telephone: <br /> Program Element: CSV Pr gram Record: O SZ RInspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No / Re-Inspection on or After: tom , <br /> OBSERVATIONS AND CORRECTIVE ACTIONSMom, (14 TV-t&(-C . ...... IAIIC;tv� W A0WONd: <br /> aJ <br /> ' f <br /> Aa -e 4_0:__WW tl. M) <br /> r—L141 <br /> ........... _ __ -- _ _- - -- <br /> ��� <br /> Li IAJ <br /> al>v <br /> Temperature Item PLocation Temperature <br /> AMMIA <br /> vYrl — Un t 671?F <br /> _t7o --'a a a facilrWater:Temperature Warewas ung <br /> Name: Hand Sink: �- of Chlorine: PPM Heat: of <br /> £xp.Date: arewashing Sink: of Ouat.Amm.: PPM 11 Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: I Time Out: t Page-Lof <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />