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SAN JOAQUIN COUNTY <br /> X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.. - iP Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> 4Cj1=�R�a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility:] ' 2 Date: —1 _ C . <br /> Address: ` , I S City: 1 zip Code: q•S 2Q-3 _ <br /> Owner/Operator: r p Telephone: "C-1 _ —104 <br /> Program Element: Progirlarn Record: Inspection Type: <br /> 8180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑t Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS 11..; NOW <br /> 0 0'r. <br /> c <br /> n1r� e <br /> 3s knt u W 2 <br /> 214 2�® <br /> O l-"- - �S <br /> 23� <br /> Item]Location I Temperature; Item I Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 1 �-� of chlorine: ppm !Heat: of <br /> Exp.Date: arewashing Sink: t of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> S vv <br /> H Specialist: Phone: <br /> Time in: Time Out: p l� Page. of <br /> EHD 16-24(2otl pg) 4/3/13 lO� FOOD PROGRAM OIR CONTINUATION <br />