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SAN JOAQUIN COUN <br /> � •.OG <br /> Q` y� 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 /> ��FpR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - / I Date: / _/a_/I <br /> Address: ' Q r^ Le City: Lo A-I' Zip Code: ay�2 4 C> <br /> Owner/Operator: Telephone: G 25--14'370 <br /> sC437 <br /> I <br /> Program Element: Program Record: ISS 7S I Inspection Type: <br /> SB180 Posted 74z es - No Permit Posted Yes _ No Re-Inspection on or After: <br /> l� OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I� 6 1 ��c �'l `> �\ �.c��.l A I f'0t ( r'I L of f yt <br /> Al�jg0Vee_S P,xse<,S Food kot tAeC coca S <br /> Item/Location Temperature r Item!Location Temperature <br /> PTS ; QViyk y y <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: ,' T� N +.� Hand Sink: l of Chlorine: ppm Heat: 'F <br /> [Exp.Date: 1 Warewashing Sink: I 3 Z> of Quat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: y4'9 _3 4/(/S;—y <br /> Time in: Time Out::06 1 :yV Page_7ofZ <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />