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SAN JOAQUIN COUNT <br /> N XENVIRONMENTAL HEALTH DEPARTMENT <br /> .'•. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sl4ov.orq/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Nu1L C c;( L10 , ` Q L 1 4 1-0 Date: �Z ?j,I <br /> Address: -- r I �I City: s1—„�1L Zip Code: <br /> Owner/Operator: ox ` �1 l Telephone: <br /> Program Element: V Program Record:- j Inspection Type: COQ 1G� �) <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 bb V.2 Cj h'O V Q d (c:c u()u� -IT) P X oryG ailh <br /> AGI4-e w cuiiir-1q boaad tr\C.1 si14-c • 1,�v A--ocO <br /> r c un be c\fm e C�+s cxa a TI-\_e_ <br /> vyvr✓fi� ecu c r G I e0 ISu. <br /> rL C u-� a, <br /> Item/Location Temperature Item/Location Temperature <br /> ---------. --..............-- -- <br /> Food <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> 4 -3 <br /> Time in: Time Out: 1 - Page I of I <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />