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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.ora/ehd <br />LIFOF <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />7tTu Date: 3 . <br />Address: I (n - <br />Owner/Operator: <br />JO lie City: _ L Q ( Zip code: <br />N- c' Telephone: <br />Program Element: 16 a Il <br />\ <br />Program Record: �S <br />Inspection Type: <br />SB180 Posted Yes No <br />Permit Posted Yes No Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />© a � S . - <br />W a t/✓x/17 ��; l o-� roo ��- <br />— <br />/�/'' <br />ac ✓t <br />rnd�a c �F' - e �- � <br />40 O <br />��s( �/ %� Clftl <br />.P1 I <br />.e' <br />dl2� ovl�• e Oat470.1 <br />r <br />avr� SrP L1 7 j a vR <br />TAe Z '( ✓eac-„' . <br />Item/Location <br />- Temperature <br />Item Location Temperature <br />QE_ <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: J%2a <br />Hand Sink: G <br />I `F Chlorine: ppm Heat: `F <br />Exp. Date: <br />Warawashing Sink/: .F uat. Amm.: ppm Other: -F <br />Received By / Titie. ) i S CL'.p � K00"4 0-- i, &f l <br />EH Specialist � a <br />ZZ <br />W Phone: 2 O <br />Time in: I a _ 2�0 <br />Time Out: I' 00 M <br />Page of Z <br />EfiD 1624 (2'^ pg) 013 FOOD <br />