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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.siaov.org/ehd <br />�FOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />of Facility: ym <br />! <br />Date: 3 <br />1213 <br />dress: +.z'/City: <br />ode: 'Iner/Operator. <br />[Na.me <br />Telephone:gram <br />Element: Program Re d:olzo 2 <br />Inspection Type:180 <br />Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />,— <br />/ 1,4' <br />.tel' <br />Wow <br />� <br />f <br />O <br />S <br />DZ <br />raa <br />Item/Location <br />Temperature <br />Item / Location <br />- Temperature <br />Fo_ o_d Safety Certification _, <br />_ _- Facility Hot, WatecTemperature <br />-. <br />- _ _ Warewashing <br />Name: nftc /.leu , <br />Hand Sink: to <br />of <br />Chlorine: <br />ppm Heat: of <br />Exp. Date: .L _ 0 G <br />7 <br />arewashing Sink: l7 — <br />of <br />uat. Amm.: <br />ppm ther: eF <br />Received By / Titie: <br />zo <br />11 _ 2?q <br />I 6 <br />EH Specialist: <br />Phone: 201 <br />^ <br />Time in: I'2-1 <br />Time Out: <br />Page of <br />EHD 16-24 (2w Pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />