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SAN JOAQUIN COUNTY <br /> 'ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �q.. J?.a�P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r Date: /d e/ Z L <br /> Address: <br /> �/� City: Zip Code: _ <br /> Owner/Operator: It Telephone: <br /> Program Element: Program Record: S Inspection v <br /> Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> too — -- <br /> f <br /> � L Zod <br /> A <br /> &r LOU <br /> l� <br /> � - a <br /> r -Lo A. <br /> 1 J <br /> _L__za 1 <br /> F— j <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification rdi�n <br /> y Hot Water Temperature Warewashing <br /> Name: k: of VQuat. <br /> ine: ppm Heat: F <br /> Exp.Date: hing Sink: 'F Amm.: ppm Other: OF <br /> Received By/Title: 2 i <br /> EH Specialist: % Phone: <br /> � ' <br /> Time in: <br /> Time Out: l� :14 1 Page of <br /> V <br /> FOOD PROGRAM OIR CONTINUATION <br /> EHD 16-24 (2n1 pg) 4/3/13 <br />