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,oea .�oG SAN JOAQUIN COON' <br /> 14, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c... ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> -0c,F o Ra <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: f r City: Zip Code: ';'97- <br /> 2- 9 W- �IctrAOwner/Operator: CIA ' 0 \ Telephone: <br /> Program Element: Program Record: 7 U' Inspection Type: C,¢ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> gyp_ I w I' -1--.-�_.-._�___.-_.-• <br /> • 1_' 0.__ .�._...C f l 1�O�—Q Y�c� T WQ 1( (.L'�\1?-__� <br /> i5 w "!%a �00se MP <br /> E3 ou,--4-0 „e - c(cam <br /> R akar f tX1 c- . <br /> Item/Location ,_Temperature Item/Location emperature <br /> ------ -- ��-- — ........ ---' — <br /> Food Safety Certification Facility Not Water Temperature i Warewashmg <br /> Name: Hand Sink: of Chlorine: ppm (Heat: 'F <br /> Exp.Date: Warewashing Sink: of 'Ouat. Amm.: PPM iOther: of <br /> Received By/Title: <br /> EH Specialist: Phone: 4(a 9'3 L9_ <br /> Time in: 2- t-� Time Out: �— Page i of <br /> EHD 16-24 (2^ pg) 4/3+13 FOOD PROGRAM OIR CONTINUATION <br />