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o4q�l" SAN JOAQUIN COUNA <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> tl FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> d —o7i` <br /> Address: 3/f Y O S Le _ City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: G Inspection Type: <br /> SB180 Posted /.Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> _ too - vi koz -c-,�t L a�vL Flo <br /> � ��6W1 - cSG�tit..t ` a—S ✓7 <br /> A su / , C U U Y h on <br /> �C h ° <br /> Me r o r t 1 , vx OL,' e1 ►'Q-ch I ,4 �e <br /> �a <br /> �Sce rpt,, -Z e se - - (a o W� �vtee�� - 0 `r <br /> duo r . a ( w k-+ W i C red rel _n - ' ° <br /> So pf <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> $` - rpt of OF <br /> Udcor- rq /O° a ms {�; c� s <br /> Food Safety Certification Facility Ho water Temperature Warewashing <br /> _.. <br /> Name: _ / ' V a-5 Hand Sink: 'F..Chlorine: ppm. Heat: F <br /> Exp.Date: / 2 / Warewashing Sink: a20 �F Quat.Amm.: `LDc) ppm Other: -F <br /> Received By/Title: T <br /> EH Specialist: Phone: <br /> Time in: q; Time Out: / Page of <br /> EHD 16-24 (2^'pg) 11/2/09 / FOOD PROGRAM OIR CONTINUATION <br />