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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: ; _Z <br /> Address: Q � P w City: Zip Code: Z <br /> Owner/Operator: /�.� e c P Telephone: <br /> Program Element: �DO Program Record: (,,,C) O--- _ Inspection Type: C f <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> G -7- /Ll G 3O0e. Qtie 1eMGs b-) 0r-1 - - <br /> �!� t1^6 <br /> Main M4n4- I_'S cnMer U cre, 4 <br /> T <br /> vv�:( Ll- or` kAoLSQcd/5eQ,— coc` S <br /> I�r c� I✓`Gi �r� •�c.� �'( er- ec'�c�I✓� T� C��S-Fa�er- `1c1_ <br /> -l>s 01L 1 5 ha c 6117-42- I c•c <br /> tiv✓l {� ✓V�-'CA � . Tl�ll S Ci,�rj'f�rn.c,� IS Ct f u��ir C�t`j'��'tC��' . <br /> � a,.� Uri M�rt��e �f" i, <br /> 40 c4tn'tpr __' C-Cu c-- cater <br /> /` <br /> Q i^l r .rh t ccy\ d C I )�� 1,s -4C(12A <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: "F <br /> Exp.Date: Warewashing Sink: of Quat. Amm.: ppm Other: 'F <br /> Received By/Title: ^� <br /> EH Specialist: ^ 1 o Phone: G, _3 41 YC; <br /> Time in: Time Out: Page ) <br /> /"z �� <br /> FOOD PROGRAM OIR CONTINUATION <br /> EHD 16-24 (2"d pg) 4/3/13 <br />