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SAN JOAQUIN COUN . <br /> �O. .CGG <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.slgov.org/ehd <br /> �l FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Y ti Date: - S - <br /> S"- 1 <br /> Address: 17 /7 S, ' t�p•� G✓r City: S.I l�n Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: i /, C Program Record: , G C / yS Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes n No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> yS9 /V1 <br /> i-�; v' d CIG S n- j Q C r i A Pe 1(S <br /> �r�✓. �Z ���:r j I? j CG <br /> 20�S C/� ( i` r� s � c, L • �� , Pc, <br /> Item/Location Temperature Item 1 location Temperature <br /> - --._ —..--- --- <br /> �Ccc,t /r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: /c g; ) 'F Chlorine: ppm Heat: 'F <br /> Exp. Date: _ I G Warewashing Sink: > 'F Quat.Amm.: ppm Other: eF <br /> Received By/Title: <br /> EH Specialist: -° Phone: <br /> Time in: Time Out: ! Pager of <br /> EHD 16-24 (2-pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />