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s�In• SAN JOAQUIN COUNTY <br />10i'�Fd' FAG <br />?a ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />�FOR� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: i � <br />ut oh Date: <br />Address: l <br />City: <br />P _ Zip Code: S. <br />Y� <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: 3Inspection <br />Type: � L, <br />58180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: 2 S <br />Azy Z <br />OBSERVATIONS AND CORRECTIVE ACTIONS' <br />a <br />-- co V�'l @ L dam• a <br />VYIGi <br />!�/ <br />Y� d <br />o i �:In 0 <br />GIiI vt Gt-i 2C ,— o S � <br />✓I ss A4 : <br />c <br />p <br />i <br />>14 >`h <br />G. <br />i <br />r, / 3 <br />,- <br />�' o _ Temperatures <br />o0 two h3 <br />-� Item / Location.. <br />Temperature <br />S%h 2 <br />_ <br />ood Satety Certification Facility Hot Water Temperature <br />eme: Hand Sink: <br />F <br />Warewashing <br />Chlorine: ppm Heat: <br />-F <br />Exp. Date: areweshing Sink: <br />'F <br />Oust. Amm.: ppm Other: <br />'F <br />Received By/ Title: Gh� H— <br />S <br />EHSpecialist. �-�AG* <br />Phone: <br />Time In:1 C <br />Time Out: <br />Page of <br />BAD 16-24 (2w 9g) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />