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aPa�l"'.s SAN JOAQUIN COUNTY <br />?• � 9c <br />z< ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.ora/ehd <br />cl••a�t'� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: C", ,� <br />--h-G <br />S Date: — Z " <br />Address r�2S <br />Cily. r C Zip Code: <br />Owner/Operator: C_Z)s <br />Telephone: <br />Program Element: ` �2 Program Record: 3S% <br />Inspection Type: _ I <br />B180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />\L C <br />7 <br />5-� <br />a <br />or v.sP ' Nr g <br />c,%e <br />C See <br />p 2 - he o. ° 1 <br />- - ]temlLo'catio <br />he <br />-- <br />TemperattWd <br />I - — C - <br />- Item /`Location <br />o <br />\tO F <br />2 ` <br />5' f <br />\•O\d, <br />VS F- <br />Food Safety Cerlificati_on. <br />_ <br />Facility Hot. Water Temperature <br />Warewashing. _ <br />Name: �_ /^ Q �. e( <br />Hand Sink: F 2 �� <br />'F <br />Chlorine: ppm <br />Heat OF <br />Exp. Date: � _ 1 — 2 <br />arewashing Sink: `o <br />of <br />Ouat. Amm.: t_l ^ ppm <br />Other: OF <br />11 <br />Received By I Title: <br />EH Specialls • <br />\_ <br />Y <br />Phone: I _ . __102-S <br />`CJ <br />Time in:`\ i , <br />Page f 2 <br />Time Out: l I <br />EHD 16-24 (2W p9) 413113 FOOD PROGRAM OIR CONTINUATION <br />