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SAN JOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT or-- 23
<br />Name of Facility: S—S C 17--: AA - ---i, d"./\ C .......3
<br />Address: City: Zip Code:
<br />Owner/Operator: Telephone:
<br />Program Element:. Program Record: :s -SISC)1/4-40 Inspection Type: \-20 i T ,,
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<br />No Re-Inspection on or After: SB180 Posted Yes No Permit Posted Yes
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<br />OBSERVATIONS AND CORRECTIVE ACTIONS
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<br />Temperature Item! Location 11IP ID Temperature
<br />0 516. •eq VD1-7A-1C.) .....2--- r
<br />Food Safety Certification Facility Hot Water Temperature Warewashing
<br />Name: Hand Sink: ,F Chlorine: ppm Heat: °F
<br />Exp. Date: Warewashing Sink: 0 Quat. Amm.: ppm Other: °F
<br />Received By / Title: 041,-- leNjik
<br />EH Specialis.t_o_c9 Phone: 2 _ 09 _ L1 6..._ ...0.2,,..3_
<br />Time in: Time Out: q 1.2.,-„,
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<br />---1%-it
<br />Page i.,V
<br />EHD 16-24 (2nd pg) 4/3/13
<br /> FOOD PROGRAM OIR CONTINUATION
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