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SAN JOAQUIN COUNP <br /> `4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.siaov.org/ehd <br /> Roft <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: t City: Zip Code: <br /> Owner/Operator: C'i7 Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> -ABSERVATIONS AND CORRECTIVE ACTIONS <br /> n R � <br /> '145 L/ 0 <br /> O <br /> ,~< 1 <br /> dV -j — - - -- <br /> ID C�AA <br /> t v-� nr <br /> Lo <br /> 2,- -- <br /> Item/Location # Temperature Item/Location- _ Tem era- re',. <br /> 1 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing _ <br /> Name: Hand Sink: -F Chlorine: ppm Heat. `F <br /> Exp.Date: Warewashing Sink: -F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: f ' <br /> EH Specialist: Phone: <br /> Time in: a Time Out: ! Pe of L <br /> EHD 16-24 (2,d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />