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SAN JOAQUIN COUN. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .. ' ;p• Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sipov.orq/ehd <br /> 4c/FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ' k1 h 6,1.1- Date: / . .J v <br /> Address: 1 C City: —T— Zip Code: <br /> 11 w, ,.,� , , �- 75,77.- <br /> Owner/Operator: i Y 1 Telephone: 1 G <br /> Y' � �+ t/ 3 <br /> Program Element: ` 2S Program Record: / 32 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: 2 � K C <br /> Sorv1 e V"01 CA I. Geli CO rb,e cls CY <br /> 1 OCbrc,i Qr% ol -" !e on be Doc, Ld o+ l fre, re <br /> Clea •- foda. <br /> ; r u le4 ne {h IGuC /the <br /> rr <br /> 0 � fr G �i+ " (//• ni. C&P cy Acl it's ;,-Iv f C <br /> ,rte 1 h G n els a I,,*- 4c 4 c .'n r 0 r a <br /> 1'11 e ho 4 PTO ✓vn I C. i . 16P i a .-a /l <br /> I. r ar dem 4C 0 , <br /> _� 11` <br /> S�r,re Uroa 1'I : 5 lads ''-n :C. tI <br /> U q ! Ec } C v; / S Gf� ! /1. <br /> Item/Location Temperature Item/Location Temperature <br /> __........ <br /> -- _.. --- -- - -.. <br /> 0 C f - do., <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: CJ Time Out: Page of <br /> EHD 16-24 (2^a pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />