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Pa"!" SAN JOAOUIN COUP. <br /> ?.. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.orq/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r'� j` ` Date: <br /> Address: `+ /1� S� City: rq C Zip Code: <br /> Owner/Operator: w ��a Telephone: 813,3- GJ9 <br /> Program Element: J Z Progr m Record: S Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ZTJJ t Gorre c�rW C cP r. <br /> P Pri-mi Orl S • f . CGrret1. in WeeK <br /> Item/Location Temperature Item 1 Location Temperature <br /> TFood Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: Ppm Heat: of <br /> Exp. Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: NAD 1, <br /> EH Specialist: Phone: <br /> Time in: Time Out:�7 Page of <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />