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�q.Pa.,co SAN JOAQUIN COUNTY <br />r. ? ENVIRONMENTAL HEALTH DEPARTMENT <br />P: -1 <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•cq.,.., `....;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />CIFOR� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: y_ �� <br />Owner/Operator: C� �, <br />ea ,/t <br />City: �, Zip Code: ':Ic� 2i1 <br />n ./t Telephone: <br />Program Element: rogram Record. <br />e �� <br />�'O�f-t� Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes <br />No <br />Re -inspection on or After: <br />- <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />0r- 2,1 <br />0\� Sc 1 <br />©� .—\63 <br />CSUtiSL �-2 <br />Item/Location - <br />Temperature- <br />Ali—Item / Location. <br />Temperature <br />►vim. L � O - b a-ck Li - <br />4 1 rte -I- <br />2d - mom <br />Food Safety Certification Facility Hot Water Temperature Werewashingv <br />Name: Hand Sink: of Chlorine: ppm Heat: <br />Exp. Date: warewashing Sink: of Ouat. Amm.: ppm Other: <br />�l i <br />-F <br />'F <br />Received By/Title. <br />EH Speea <br />me in: lallst <br />T'I1 1 G <br />1 _ <br />V" l <br />Phone: -2 � 7 <br />Time Out: 1�'J��\A Page, of <br />FOOD PROGRAM OIR CONnNUATION <br />EHD 16-24 (2'° P9) 4/3/13 _... <br />