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PQu�k SAN JOAQUIN COUP t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4.. Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sl4ov.orq/ehd <br /> �1Foiya <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: FG Date: 12- -9 —I <br /> ddress: 3.2-0�t m �r ) _ +Orl <br /> Owner/Operator:or: [�✓1 City: Zip Code: <br /> Telephone: p � c <br /> ��b'c�710�`� <br /> Program Element: Z� Program Record: T 9--0 I w'Z'S 40 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> L O <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �rz r e- Li rLe-- --Lo v, w I1 ---ass <br /> -4- ren d e r ) W-e-e r-_ a n c) <br /> a� n ez <br /> oOL r LOQ5 6enj4_ c)g_ door o1 a q <br /> rs rie kH r,-f -e <br /> (� -t y yyu <br /> '►o "11 (Q <br /> 42 roU n t + aA r <br /> -tD OL <br /> 6D YnA k`Dt4zx� I CAAa )n <br /> �o ✓ I t5 00 r5 C1 r'-e- n of <br /> E <br /> I <br /> Item/Location Temperature Item/Location Temperature <br /> _ i - --- -- _-- <br /> Food Safety Certification Facility Hot Water Temperature — Warewashing <br /> Name: Hand Sink: F Chlorine: Ppm iHeat: F <br /> _............ ......... -- <br /> Exp. Date: arewashing Sink: `F iQuat. Amm.: ppm i0ther: F <br /> Received By/Titie: <br /> EH Specialist: Phone: '4!J n <br /> Time in: .�Z.66 Time Out: 2 , ! Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />