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SAN JOAQUIN COUI <br /> . t <br /> Z. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �rFou <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / C Date: <br /> Address: (�, /r City: zip Code: <br /> Owner/Operator: Y� 42 j Telephone: <br /> Program Element: l 3 Program Record: / Inspection Typ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS, <br /> CPG/_ ........ _... . ....... ........ <br /> : 1; <br /> tfemtLaetlatt Tein nenature liem l Location <br /> Tiieratur6 <br /> Faoti;5afetyrtrflc�UonFacilrty Hof Water:TemperatureWarewashing <br /> Name: Hand Sink: � °F Chlorine: ppm Heat: `F <br /> Exp.Date;7P �� / arewashing Sink/�� of Quat.Amm.: ppm Other: of <br /> Received By/T' S,�V(, V--r,Cr r-r--Z_ a C` D_Vzzc,l� <br /> EH Specialis : Phone: <br /> Time in: ��`-�/ r Time Out: Page <br /> EHD 16-24 (2^d pg) 4/3/13 o FOOD PROGRAM OR CONTINUATION <br />