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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.siclov.orgiehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: A-- \ ‘ ii re:If --0-/-i-e.._ f \Ak \C.,it — Date:
<br />Address: 1 \'i , •.--.
<br />f\(NC-1`•:s (NOVO( City: k .)1 /4.30 Zip Code:
<br />Owner/Operator: Telephone:
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<br />FSB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS r;
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<br />Temperature
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<br />Facility Hot Water Tempera Warewashinme.
<br />Hand Sink: . Chlorine: ppm Heat: ,
<br />Exp. Date: Warewashing Sink: 0 Quat. Amm.: ppm Other: ,
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<br />EH Speciali
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<br />Phone: 209 ___ \ 10 ...._c.2 5
<br />Time in: , 2_9, 0\
<br />Time Out: Page2f_
<br />EHD 16-24 (2^d pg) 4/3/13
<br /> FOOD PROGRAM OIR CONTINUATION
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