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0P°"I SAN JOAQUIN COU, <br /> 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 /> �IFORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J C` – Date: <br /> Address: zt&e' " City: Code: <br /> Owner/Operator: Telephone: <br /> Program Element: rogram Record: L '— Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or Aft <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1en0 rr <br /> r ./ r <br /> 61 el <br /> v� v ' djQ <br /> .. r <br /> PILI NMI ev <br /> Q` Ve <br /> ® l�� rre <br /> lei o 7-s <br /> Item�cation Temperature tion Temperature <br /> I aot Water Temperature Warewashing <br /> Name: v r C .,l-h Hand Sink: ( `F Chlorine: ppm (Heat: of <br /> Exp.Datd: 7 arewashing Sink: .7 `F Quat. Amm.: ppm Other: 'F <br /> Received By/Title: l/ <br /> L <br /> EH Specialist: L Phone: <br /> Time in: Time Out: Pag of <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />