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o.P4"'" C' <br /> SAN JOAQUIN COUP_ . t <br /> , . <br /> Q` za ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • oq.. 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: �y t1 l� 2 {� Date: -7 <br /> Address: City: Zip Code: 9 <br /> -) G o <br /> Owner/Operator: ( iN" Telephone: '001- 37r j <br /> Program Element: c Program Record: , Inspection Type: <br /> SB180 Posted _ Yes No Permit Posted Yes L No Re-Inspection on or After: <br /> w <br /> rov of !ti 0Vic,is Cr h S )C u <br /> PAVA ruW , ) if n C1 i � <br /> W#0K5 <br /> arc1 V <br /> one . G ; 1 rn h -r tn�► to -a0:1; 4 4 <br /> cul a It S a rY► 1.7 n '0 iC, .1 c he ji <br /> /633 <br /> 4s <br /> G or l 01)( C Pe have pr. a;/ <br /> . <br /> 0 lur , G G f-c, <br /> ( g h It,, Ion le- gpa <br /> { � a <br /> �6.A )ql 1, 1\ 6 <br /> Item/Location Temperature s, Item f Location Temperature <br /> am" -Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title % - <br /> EH Specialist: Phone: <br /> Time in: Time Out: v Page <br /> EHD 16-24 (2°d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />