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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.si0ov.org/ehd <br />CIFOHN <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />p L/ <br />Date: f Z <br />ddress:JCZ2 <br />mi, <br />�l <br />City: <br />Zip Code: <br />Owner/Operator: <br />r <br />Telephone: <br />Program Element: <br />A <br />Program Record: I� D r; II e <br />Inspection Type: v� <br />SB180 Posted Yes <br />No Permit Posted Yes No Re -inspection on or After: <br />�I <br />ERVATIONS AND CORRECTIVE ACTIONS <br />- - <br />fw <br />C '4t42Lil <br />- <br />ItemlLocetio <br />Food Safety Certification <br />Facility_ Hot. Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: 'F <br />Chlorine: <br />Ppm Heat: of <br />Exp. Date: <br />Warewashing Sink: "F <br />uat. Amm.: <br />PPM Other: 'F <br />Received By I Title: <br />EH Specialist: <br />!' <br />B <br />Phone: <br />ime in: <br />Time Out: <br />Page of <br />EHD 1624 (2 -pg) 413113' / FOOD PROGRAM OR CONTINUATION <br />