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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.sogov.org/ehd <br /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r1 `1 u✓ 0 ° Date: <br /> Address: 25 2 C , v 'DOVOL-) S`_ City. � G��� Zip Code: "15 (0 <br /> Owner/Operator: `e1011 tam <br /> mY/ T'�` "T Telephone: 11%0 , 2LU <br /> Program Element: ,(49 �-4. Program Record: tj l <br /> o(- 1 0G � <br /> Inspection Type: AlrQ <br /> V81-80—P—osted ❑Yes L1Rermit Posted 11 ❑�Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTI `7 <br /> Sqt�l h^ r r C CIVT-eG i\ - <br /> U 2 n � ccr e t j <br /> q v e uclu CUA C� (11rR <br /> c,wn CSI_ C <br /> do <br /> re numo W> A�v s -n 'A%2 d <br /> l�Q <br /> CP�hfiCOl S OIM r - Ok <br /> n o� -�n Cob <br /> ( , <br /> Item/Location <br /> Temperature Item l L ocaUon; � <br /> Facility Hot Water Temperature Warewashing <br /> Name: 1 Hand Sink-. 'F 'Chlorine: ppm (Heat: of <br /> Exp.Date: 2/� 1�G� arewashing Sink: of Quat. Amm.: ppm �:Cither: of <br /> Received By/Title: T <br /> EH Specialist: Phone: !1✓ r C6 <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />