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,oP4 .�oG SAN JOAQUIN COU' ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s*gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ' �` `._� Date: <br /> Address: 9100 JC s A City: codll� <br /> Zip Code: Q <br /> Owner/Operator: v'\e A W c SC's—^ Telephone: 3lo -,I L4 I <br /> Program Element: `t.,? Program Record: ,52-1-S 14 Inspection Type: <br /> SB180 Posted r'Yes 7 No Permit Posted Yes n No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 222 I <br /> IJ CW\.) <br /> l 003 <br /> cam. . ¢ r d <br /> a <br /> SAke- <br /> C\ C> <br /> 1 I � <br /> n 1 <br /> C <br /> C-0( mem w <br /> 1 - F <br /> .,v <br /> Item/Location Temperature item/Location iiTemperature <br /> _ ---- — — --- <br /> 447,(—) _ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: Chl rine: pp Heat: <br /> Exp.Date: Warewashing Sink: �F Quat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: 1, ko t��033O <br /> Time in: C `I G Time Out: , ^ : 2 Page lof <br /> EHD 16-24 (2n'pg) 4/3/13 J Jv FOOD PROGRAM OIR CONTINUATION <br />