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Lu III SAN JOAQUIN COUNTY <br /> ...... <br /> ' a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ... �P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> 'QCjFOttia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,S ` Date: <br /> Address: S \ city:--�.� Zip Code: Cl S 391 <br /> Owner/Operator: Telephone:3 Z 3.. -314 - 19 <br /> Program Element: 110 Program Record: Is y Inspection Type: 1�� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: t <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> C� 04 q -�so S 1t , CA CZXAQ�r4 <br /> vA <br /> C,t7 '4 3 S s " <br /> b0 <br /> 0 <br /> W <br /> s -e Cc c.:�w r c� <br /> o-a r . <br /> w� <br /> Item/Location Temperature Item/Location Temperature <br /> s <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: Ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: `F <br /> Received By/Title: P1 C-crk \ - <br /> EH Specialist: Phone: <br /> Time in: i Time Out: . Page`of I <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />