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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.org/ehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: '5.3 C :I - \A Date:
<br />Address: ;,kot ,.D C--C__A c--:; C._ ANrC.-
<br />City:Sk.oc*A_Liv Zip Code:
<br />Owner/Operator: Telephone:
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<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS Cc . \ Cc-A
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<br />Temperetu Item / Locttion
<br />Food Safety Certification Facility Hot Water Temperature Warewashing
<br />Name: Hand Sink: o F Chlorine: ppm Heat: °F
<br />Exp. Date: Warewashing Sink: o F Quat. Am m.: ppm Other: °F
<br />Received By / Title:
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<br />EH Specialist . ......i,
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<br />Phone: -7 ocik _ k(:), li 10 ._ 3c). 2._..
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<br />Time in: --7 ,..51--s cn Time Out: Page. of
<br />EHD 16-24 (2^4 pg) 4/3/13 FOOD PROGRAM OIR CONTIN
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