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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.sicov.orgiehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility:--- --....7 ----S, c • F.-- IV \ Date: (Lc_ Li _ 2. 3
<br />Address: k_,k 9 -30 c,.c cA, c A\res. City: SA"...... Zip Code:
<br />Owner/Operator: Telephone:
<br />-7_ Program Element: \ kRj a /rgram Record: ‘ iooct Li / c- u..)-- \r`Q / . 1 6i st s 0 -•cl
<br />Inspection Type: rk%ftk
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />' OBSERVATIONS AND CORRECTIVE ACTIONS =MI
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<br />Item/Location Temperature Item / Location Temperature
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<br />ood Safety Certification Facility Hot Water Temperature Warewashing
<br />Name: Hand Sink: .F Chlorine:°F ppm Heat:
<br />Exp. Date: Warewashing Sink: .F Quat. Amm.: ppm Other: °F
<br />Received By / Title:
<br />Phone: -2_0 (7.-\ _ c::2) k to ,,_. 0 as EH Speciali cigLot.m....4......r.4z
<br />Time in: Time Out: Page of -'--
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<br />END 16-24 (2nd pg) 4/3/13
<br /> FOOD PROGRAM OR
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