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SAN JOAQUIN COUN
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov.orq/ehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: . INNe j:i c•- ..,,.....al Date: q ,_ , 0 . i s "" B ta Li 81..S.E)
<br />Address: k( -2.,./-:-.) r..\ 6,,\J„.„1,,,,,,.4..\_,,...,5A, -,___S-RitY:"7"(0, Zip Code:
<br />Owner/Operator: Telephone:
<br />Program Element: Program Record: Inspection Type:
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS
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<br />Food Safety Safety Certification Facility Hot Water Temperature Warewashing
<br />Name: Hand Sink: ic E oF Chlorine: pp, Heat: °F
<br />Exp. Date: Warewashing Sink: ,s- oF Quat. Amm.: PPm Other: °F
<br />/ Received By! Title: Id
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<br />EH Specialist' Phone: ;...i ?)..,__0.... .,...7,...:,.. ,4....„.. -,--,-.4--Ne7,.
<br />Time in:‘ cy, 4,2_,„\ev..., Time Out: \ t \.400.y.y....\ Page of i
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<br />END 16-24 (2^, pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION
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