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SAN JOAQUIN COUN <br /> z 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 /> ��FORt•� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 {: .1�4 Date: <br /> Address: i" City: / /uC 1 Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> (v 1V 9 a so n-7c- C i s t. e <br /> 6180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ia <br /> I / Ll 3 Y r) : e en <br /> q i <br /> SS uc d c,,) <br /> GC I;4. / ry) GS.F a w . Y1 �, C,r+Y 0r ^r or <br /> Y P 4 i I- 1 !=Y J1 J o ! Y: CP fee <br /> _.;. Itam/Location Temperature Item J L.t?t: ttpn T nt aerature <br /> Food Safety Certification ,,.Facility Hot Water Temperature Ware was hing <br /> Name: , Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: 'F <br /> Received By/Title: o <br /> EH Specialist: \ \1 Pho e: �! <br /> C� <br /> Time in: Time Out: Page of <br /> Io <br /> EHD 16-24 (2°°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />