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�Y <br /> SAN �IOAQUIN Cor <br /> �o . ........c <br /> � •.OG <br /> Vl: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..• a�P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.orq/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 4 74 Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: 1 <br /> Program Element: �n/ Program Record: `1i w), Inspection Type: 1 <br /> SB180 Posted Yes No Permit Posted Yes No C(/ Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> w <br /> Item/Location Temperature Item/Location Temperature <br /> GW�-l -�' Ll,e�:.' �' V � • �—�_ � 1��t'i V ?.�d vLU'LYY' lyL��./,VT�/l -� f.__ <br /> GtibtJ G-j� i �� L <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Si": of Quat.Amm.: ppm Other: of <br /> -iceived By/Title: <br /> Specialist: Phone: <br /> in: ( r '�d'1/n Time Out: Page of <br /> < <br /> 4 (2-pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />