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P°u'" SAN JOAQUIN COUN� <br />'-� 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 />S�/FORS' <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: �, <br />��i4, <br />Date: <br />D--Gl (S <br />Address: /I <br />V <br />City: <br />Zip Code: <br />Owner/Operator: <br />/w� n� <br />Telephone: <br />�J <br />Program Element: / �. <br />([ <br />Program Record: � (�� <br />Inspection Type: <br />VL7 <br />B180 Posted _ Yes ❑ Rermit Posted Yes ❑ 1 Re -Inspection on or After: <br />i <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />dA CUYY\j- <br />IYU <br />_ktD <br />i'1 -r— `(.k1,9-! <br />410 <br />IV V <br />x Item ! Loc i 0 , <br />Temperature , <br />Name: <br />Exp. Date: <br />Facility Hot Water Temperafure� <br />Hand Sink: of Chlorine: <br />Warewashing Sink: of Quat. Amm.: <br />Warewashing� <br />ppm (Heat <br />ppm (Other: <br />of <br />°F <br />Received By / Titl C <br />; ' <br />1 <br />EH Specialist: <br />Phone: <br />Time in: <br />JI7 Time Out: <br />Page of� <br />EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />