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SAN JOAQUIN COL. .---Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c " cp Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> dt1s6'A�' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C �• , - Date: i /KI 4.1 <br /> Address: •It,S City: zip Code: <br /> Owner/Operator: �� Telephone: <br /> Program Element: ogre Record: jz'Q Inspection Type: O <br /> B180 Posted Yes Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> J_ _ tVQM <br /> Crrrh S F J <br /> z 'a <br /> 0 <br /> - l <br /> S r'I fc'»! i ; <br /> &0 -0A cl-isb J o r <br /> 0 1� ;tiF,C <br /> � <br /> oV-- <br /> a <br /> e Ir/ nral 14e <br /> Item/Location Temperature /Low n Temperature <br /> 3 <br /> i ►' rS r <br /> Food Safety Certification Facility Hot Wat Temperature Warewashing <br /> Name: and Sink: f t .F Chlorine: D� Ppm Heat: .F <br /> Exp.Date: arewashing Sink: 11 'F Ouat.Amm.: ppm Other: -F <br /> Received By/Tit <br /> EH Specialist: 27 <br /> -- <br /> Time in: /,/ Time Out: g f <br /> Y" 4 <br /> EHD 16-24 (2^pg) OV13 IFOOD PROGRAM OIR CONTINUATION <br />