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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.orWehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: N\ 4...{., \--:‘(--..) z t— "A Date: - k _ 23
<br />Address: City: Zip Code:
<br />Owner/Operator: Telephone:
<br />Program Element:\ tot / 1 bc&ogram Record: -5- 2_03.2..) s ...i z 0,3 -.1, Inspection Type: r ..A......e ) -1....
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />OBSERVATIONS AND coRREpayE AcTioqs .
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<br />' Item/Location
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<br />Temperature
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<br />ood Safe Certification Facility Hot Water Temperature Warewashing
<br />Name: Hand Sink: of Chlorine: ppm Heat: ' F
<br />Exp. Date: Warewashing Sink: .F Quat. Amm.: ppm Other: °F
<br />Received By / Title:_,J) C '-i-/ii ji) t
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<br />EH Special s,...c.€ j...___\..-; v , Phone: :2 c.), _ to k ),c,,3.2....s.
<br />Time in: Time Out: \ \ a •_( Sir., ,- \i'- Page.„pf
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<br />EHD 16-24 (2^d pg) 4/3/13
<br /> FOOD PROGRAM OIR CONTINUATION
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