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SAN JOAQUIN COUK <br /> p .. <br /> Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Cq��FO,tia�P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.si4ov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �,� t 2 ;C ��4 Date: <br /> Address: 1 Cit j�,� ty <br /> �� S 1 ( rT 1� y� `S 1�-'G1� 1" � Zip Code: <br /> Owner/Operator: n k L•, n Telephone: <br /> Wk" <br /> ee01 / <br /> Program Element: �V35 Program Record:1 [J� 0"!_70 0 51rj- 6-1— Inspection Type: `o gWcFET) <br /> IS 8180 Posted ❑Yes ❑ Rermit Posted 1 ❑Yes ❑1 Re-Inspection on or After: p v1 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l d Vu oard'-­. CM Si i Lor <br /> IS CCfi�1h� Q� .j \� Lor <br /> 1 <br /> zn O vie,I <br /> o SI�'�•� CW_ C a c 6 fiS 1Q_ CA -K1 <br /> Of AK `N I[l/T- F ISCUn}in G - C� <br /> CAI-d1 o r -� - <br /> �- NU _d rdr U - v v i 61a GAS Soo h a <br /> o SS i <br /> w 1 • Th-e�J2' IS h a <br /> re el'%T 4ed C iW <br /> Cx,-j qQ,,f- OnAl (f rgedS ' cN e _eon, 'FOC CLS Soh Gc S <br /> osS I tS a VF &-r WICsw . <br /> Item/Location Temperature Item I location Temperature <br /> Food Safety Certification Facility Hot Water Temperature ,� ;,.Warewashng <br /> Name: Hand Sink: of Chlorine: ppm rt, <br /> at. of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppmey: of <br /> Received By/Title: <br /> EH Specialist: Phone: r 6 �r•� <br /> Time in: ( \` Time Out: I J Pag o <br /> EHD 16-24 (2n1 pg) 4131,13` FOOD PROGRAM OIR CONTINUATION <br />