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`�'" SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sagov.org/ehd <br /> �/FaR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: CA 00 m Date: O ` <br /> Address: 7,rte, `� y r b City: l'tcc�_-vn Zip Code: <br /> Owner/Operator: J JCA �(AU r 1_ Telephone: r„/„�; y2-coci <br /> Program Element: W O Program Record: c � U Inspection Type: c�oC)C-4A <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> L .�ZZ <br /> 7'r, 7 <br /> ��UV 1&c cxN `)Came, <br /> 1� t SSV► �� Ckk`-ice The <br /> Item/Location Temperature Item 1 Location Temperature <br /> 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: j Phone: /1 ,+✓. ,d � 34 4.(� <br /> Time in: Time Out: ,(/j O�T Page Of <br /> EHD 16-24 (2n°pg) 4/3/13 "t FOOD PROGRAM OIR CONTINUATION <br />