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SAN JOAQUIN COL <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.sl-ov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: n° r Date: j —'3_16 <br /> Address: 'w-� 1 (fire � \ ,,r t 'Dir City: � Zip Code: � <br /> Owner/Operator: ` v�CTelephone: <4 6 O $� <br /> Program Element: ('P / _Y Z <br /> Program Record: ("� 23� Inspection Type: Q J,-H K� <br /> SB180 Posted Yes �NtoPermit Posted*Yesl' No Re-Inspection on or After: QAk' �� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Ti + i,�cA r� t u o�_t l� — ry t,t�} <br /> ci Li <br /> (%,n U-04-h I a c�V- 6An»S ac-4cs U d . Pro V_ da.. U AA <br /> r eA,tt TpOa <br /> OT r A wa S ke <br /> 66 <br /> Item/Location 4vL�r5 Temperature item/Location S"+c;r,4 a'-s Temperature <br /> n u 19 5+n-4 r &I� Lf 64— Cs 3(o F <br /> Z mor `-f'ru-r_ '� �(� 2 1 33`'F <br /> o4a.+w3 4 o Ccte r I`I y 5ct LhPO 3q t_ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: i 0-7 'F C` ^ � � -)PPmF�qat: r °F <br /> Exp.Date: Ware ashing Sink: of Oat.Amm.: � PPm Other:(, of <br /> Received By/Title: <br /> EH Specialist: Phone: _ ' <br /> Time in: 0 <br /> I G Time Out: % I : Pag o� <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />