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SAN JOAQUIN COUN <br /> 4 y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq.. =a ;a�P. Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si oq v.or /c/eehd <br /> LrkoR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ef, Date: I—I Is— I S <br /> Address: 2 ` Or <br /> City: Zip Code: a S 2--( 2 <br /> Owner/Operator: ji; `;A CA L <br /> Telephone:b 0S_ O I_ p 13 <br /> Program Element: i\ooq ogram R ord: Inspection Type: ,�f'e, <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> — ��---- <br /> CLI, 1 2k 111 o--_2 cA yVjXA-..-_ 1. <br /> e ;Item/Location 3s?einp nature Item/Location Temperature <br /> � 1`rdSafetyCertification Facility Hot wafer Temperature Warewashing <br /> ,_. <br /> Name: Hand Sink: 1 ZU of Chlorine: m pp <br /> Exp.Date: Warewashing Sink: L1 of Quat.Amm.: ppm Other: of <br /> Received By/Title- <br /> EH Specialist: Phone: 14 <br /> V& <br /> _Q,�f�2�/� <br /> Time in: i .' 0 Time Out: 'l YJ`V`�,V J Pag� of I <br /> EHD 16.24 (2nd pg) 4/3/13 J FOOD PROGRAM OR CONTINUATION <br />