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QU�N SAN JOAQUIN COUN <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q ••.•�•,�;;c Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov•org/ehd <br /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Tctc;K To i I,1L Date: _ to /Y <br /> Address: Gr q City: I r C1 cy <br /> Zip Code: :G <br /> Owner/Operator: . , V r 1 ✓ Telephone: <br /> Program Element: Program Record: { S Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> G5 V:O)fA t ons COrree-�r - <br /> _ /A n a� 'k- i n �!P��._r.._.�.____..........._.._.._---- <br /> 40 day---- <br /> . <br /> _. .. - <br /> ItemlLocatibn Temperature Item!Location Terri�t <br /> �. ; <br /> Food Safety Certification Facility Hot water Temperature Warewashing <br /> Name. Hand Sink: nF Chlorine: PPm Heat: F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: PPM Other: nF <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: �G.� O Page ,of 1 <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />