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SAN JOAQUIN COU,,,WY <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 /> RL1 PO'Fil, <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: coob S1 Cie lµa( Date: <br /> Address: 2, 22 xx� City: cltvL"131" <br /> Zip Code: <br /> Owner/Operator: "ObCA" rnCAd 1R-r 910 ,C Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> 08SERVAT-1 0C S A tD CL RRECTIVE ACTIONS <br /> - �UUGiIt SAS A oew cNVrx'X- - <br /> - N&V DX I- nA.-e-dS tx> -ir p, 1'ZC�ihi C1vv __ .s <br /> tternlLocatrort 3sn s+atrue'" l em 3:ocatfon+ Temperature <br /> Food'Safe "Certifica#ion .. i" Facrtity"f of waterTern attire Warewashing . <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: fwarewashing Sink: of Quat. Amm.: ppm ther: of <br /> Received By l Title: X1/1 <br /> EH Specialist: Phone: <br /> Time in: U5 Time Out: Page o <br /> s <br /> ErI016-24 �2"ap9) 4,'3",3 FOOD PROGRAM OIRCONTINUATION <br />