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SAN JOAQUIN COUNTY <br /> IQ:Q` X ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.orq/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 77 <br /> 7 <br /> ddress: \ 'Sy <br /> City: Zip Code: 9 2 <br /> Owner/Operator: (CA I \-)(. ; Telephone: <br /> Program Element: \ Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 11 - <br /> 0 <br /> ,- <br /> 2 - S; h <br /> 2 <br /> 1QAX4--\- \ <br /> S rVj <br /> .-2, <br /> ) ExuA <br /> ;ll, a=`ItemlLo�ation Temperature Item 1 Location " Temperature <br /> �•~ _ _ <br /> S r <br /> Food Safety Certification ility Hot Water Temperature = Warewashing <br /> Name: Hand Sink: �L I of Chlorine: ppm Heat• of <br /> Exp.Date: Warewashing Sink: I of Quat.Amm.: ppm Other: of <br /> Received By/Title: D- 5 i ( _ <br /> EH Specialist: Phone: <br /> Time in: 1 2� Time Out: ` ,^ Page lof <br /> EHD 16-24 (211tl pg) 4/3/13 �J FOOD PROGRAM OIR CONTINUATION <br />