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oP41'" SAN JOAQUIN COUi <br /> �. c .pG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ... ;P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> 4C%FQµ� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -T&- 5 rCA =5 _ I Date: _ Z _ <br /> Address: O r rte S+ City: +0Zip Code: 015 210 <br /> Owner/Operator: Z0 ], % r0 � ) I V Telephone: 2 0-to <br /> y <br /> Program Element: , b 03 Program Record: n r� I Inspection Type VHq <br /> an <br /> SB180 Posted Yes No Permit Posted Yes No / Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ol <br /> z*ki .5-1 d s 0-F Pv�cJ_a_ 0 w r e r s nar >n . <br /> 0 Y t" (j "I <br /> „v ; .ea, jrto <br /> U <br /> e r� <br /> are " ck ery+ Aro baile-n2, Gn►�►-� �-f min,-� <br /> Prov <br /> 6 wo con "5A tAj OrK�'� <br /> c.L or►�l a►-m,�_-k r ro v-i <br /> Y-0 m 5 <br /> r a ` cam- Yg_> �e_5 ►-+ <br /> Item/Location Temperature Item/Location Temperature <br /> r-,;0L+0 r o� <br /> .... . <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: FZ� of Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: 1 of Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: O M 14 <br /> EH Specialist. aN; Phone: pts _ <br /> Time in: C Time Out: 1 r Pag of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />