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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />a4�IFok�;e Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />f ' /Y L -J <br />-" _'J Ij ( <br />Date: F <br />Address: ? <br />7 <br />Al <br />® <br />City: /r <br />L <br />ip Code: <br />Owner/Operator: <br />/1 G yF - �" <br />Telephone: <br />Program Element: <br />Program Record: <br />Inspection Type: <br />8180 Posted <br />No <br />Permit Posted ! Yes' No <br />Re -Inspection on or After: <br />T <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />r. Ur a <br />l <br />IQ'- f7 - V V <br />7-7 <br />Item/Location <br />Temperature <br />"Item I Location <br />Temperature <br />FoodSatety Certification <br />- <br />Facility Hot Water Temperature <br />Warewashing;; <br />Name: <br />!Hand Sink: <br />of Chlorine: <br />ppm <br />Heat: <br />'F <br />Exp. Date: <br />iWarewashing Sink: <br />`F Quat. Amm.: <br />ppm <br />Other: <br />'F <br />eceived By I Title: <br />�+.�� <br />GH <br />Specialist: <br />I <br />i <br />Phone: <br />ime in: -: <br />Time Out: <br />Page of <br />EHD 16-24 (2w g) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />