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SAN JOAOUIN COU. V <br /> _ y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ..i FOR ;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> La <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: anc) fan-16f -}t► 41� (!�( ( j}�� . Date: <br /> Address: S cc, <br /> Iif <br /> City: � Zip Code: <br /> Owner/Operator: ; Q ric) Telephone: <br /> Program Element: Program Record: Inspection Type: R <br /> SB180 Posted Yes No Permit Posted Yes No JCJ Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS F <br /> FOL rte '(. (OaY-inq k7atcaterr e t (AC)CAS <br /> - - <br /> 0JjS%CX <br /> 2i nd 11 <br /> _n <br /> -�E c anryt P e ti t vey " k a Y-je 1n5D.ecA cn-1 <br /> Item/Location ( Temperature Item/Location—,__ Temperature <br /> ... .......... <br /> Food Safety Certification ( Facility Hot Water Temperature Warewashing <br /> Name: (Hand Sink: `F Chlorine: ppm iHeat• F <br /> Exp.Date: (Warewashing Sink: F iQuat.Amm.: ppm Other: of <br /> Received By/Title: 1 G L4-1L�`1l- I,o <br /> EH Specialist: Ly w Phone: ab4rl <br /> Time in: Time Out: 10 : 1 O Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />