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oPg41 SAN JOAQUIN COUN- <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si-gov.org/ehd <br /> <<FORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Dem 1RA • Lt!;? LAny-S IL Date: - 7- , '7 <br /> Address: T�of-� L�� City: S+b je Zip Code: 52 L� <br /> Owner/Operator: qK I- u T + Q�I � [ Telephone: <br /> Program Element: 6 t 5 Pr gram Record: O �6 O Inspection Type: Ou <br /> S8180 Posted es ❑ No Permit Poste Yes ❑No Re-Inspection on or After: <br /> '-� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a hS A v o <br /> v3q l•*_r- !;j7 <br /> Item/Location Temperature Item I Location Temperature Item I Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: j C)( f Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: °F Quat. Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: S <br /> Time in: ! , Time Out: , Page pf I <br /> EHD 16-24 (2"^pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />