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SAN JOAQUIN COUP <br /> �-. ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq.. .a;P.. Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.slgov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -Th -` _o- - e UC):�A 'X \ Date: G I <br /> Address: LC t I � City: S o✓ � Zip Code: <br /> Owner/Operator: AC�1 h-CNV-A Telephonerw—(�� <br /> Program Element: ,z 4 Program Record: Q \ C{ Inspection Type: L� '-� <br /> SB180 Poste Yes No Permit Posted Yes No Re-Inspection on or After: weel1c� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> TRZ 61,'Se 1-h.(-/ ' CCXAP bine <br /> Y�-2 .N Slim fVv+ -h L v`' 31'b' Cwi . ccv-->LV--4e- n 'Z <br /> TNA-E -1 t ti 1 ThQ_ *6051 Q h 00:�A_ -5 fiefs• <br /> n b0TVAA 1"-,-e vect&Ki 11 Cou <br /> ell <br /> P,ArG <br /> p�coae1 <br /> `g on . i 101 - all file <br /> G C/o� r � fide- <br /> d n )t-s-tcke Cvrre -rzx�IG+ <br /> N a <br /> F . .. <br /> �ri�Ol - CQ I cow <br /> eC�l l�'11 CCK-Q�n �� <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: °F Chlorine: ppm Heat: 'F <br /> Exp.Date: vV (l 2� Warewashing Sink: I' -F Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: �,-1 f <br /> Time in:�� :�� Time Out•:LI,JZ"li' U Page of Z <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />