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QU�N SAN JOAQUIN COUNTY <br /> �ag .cac <br /> F. ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax_(209) 464-0138 Web:wwW.sla�v orq/ehd <br /> Qci oaf <br /> 1 FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - CA + en Date: �� 23 - l' <br /> Address: O 2,3 LJopL City: G U Zip Cade: 9-S 21 Q <br /> Owner/Operator: J Telephone: <br /> C S , <br /> Program Element: Program Rec rd: L� 3�Ojy Inspection Type: LC�i N <br /> SB180 Posted '❑Yes ❑ Na Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS At [7 CDRREC7"IVE ACTIONS <br /> c <br /> MFL s, L, 46 Ll.,j 11/q C- <br /> M . r10T ba <br /> S da vzz�Cs <br /> • b lt'emlLocationa Temperature T., r Item lLocatian :Temperature <br /> a <br /> Foad Safety Certification;. Facility Hat Water Temperature Warewashing <br /> _.. , J-F <br /> Name: Hand Sink: of Chlorine: ppmHeat:Exp.Date: Warewashing Sink: 'F Ouat.Amm.: ppm Other: <br /> Received By 1 Title: <br /> EH Specialist: 4~J^ � Phone: <.� 39 <br /> Time in: ' Time Out: 12-' 00 <br /> 2`u0 7 Page of <br /> � � 1 <br /> EHD 16-24 (21d pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />