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°u!" SAN JOAQUIN COUN <br /> •.OG <br /> Q \ za ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4c;FORa <br /> ;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ) •I Le )P-c o M� Date: 2C <br /> ddress: Jt,Gtifi� 1 �^�.r City: �,{-r�r U ,}�T Zip Code: �l K2r <br /> Owner/Operator. �! r� i fi r1 C CA • `Telephone1 — I Ci <br /> Program Element: i (CCrp� Program Record: U}' j ( 7 <br /> Inspection Type: `U1)Cxk*A.}.1on <br /> 6180 Posted 1 ❑Yes ElRermit Posted ❑Yes ❑( I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> doCANnCAftjn afirt�- 1 ' �v <br /> va i cA.e <br /> C>-�- <br /> Temperature <br /> Warewashing <br /> Name: Hand Sink: of chlorine: ppm Heat: J'FExp.Date: arewashing Sink: ofQuat.Amm.: ppmOther: <br /> Received By/Title: <br /> EH Specialist: 7 Phone:.1 <br /> Time in: Q, _ Time Out: :96 Page of <br /> EHD 16-24(2r'pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />