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SAN JOAQUIN COW <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> W., <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si- ov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C. Date: <br /> Address: 6 City: Zip Code: <br /> Owner/Operator: Telephone <br /> Program Element: Program Record: 61 Inspection Type: <br /> SB180 Posted Y No Permit Posted Ye No Re-inspection on or Afte <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 4tW <br /> do A4.) <br /> JUA JeV PIC'e-d 14-4 <br /> V <br /> V <br /> J-) /!,2Y7*i4te44-1 4b 6441UA4ez ykar <br /> 2W 4eeze-, � "*Le"V-eeoza.X <br /> V <br /> ................ <br /> .................. <br /> A......... <br /> V I/ V 17 <br /> 16/3 ................. --------------L <br /> V V J <br /> Iteni/Locationjemperature Item I Location,, <br /> /k- <br /> 0--t-: 'F <br /> 01 <br /> Mt. ................ <br /> Facility Hot Water Temperature Warewashing <br /> .............. <br /> PppmName, 4,,OA Hand Sink. of Chlorine: at: of <br /> [Exp.Date: 1.91 Warewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Tit le: I <br /> EH Specialist: V Phone: <br /> kkd"10L'A ...................zq- <br /> Time in: V 10:jkl Time Out: Page of <br /> E HD 16-24 (2111 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />