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Zip Code: <br />Telephone:Owner/Operator: <br />Program Element: <br />SB180 Posted <br />(' <br />■nA <► <br />Temperature Item / Location TemperatureItem/Location <br />TFood Safety Certification <br />Chlorine:°F <br />Quat. Amm.:Warewashing Sink:°F°F ppm <br />Time in: <br />o <br />San Joaquin Cow . <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/ehd <br />w_Z/ <br />Facility Hot Water Temperature <br />Hand Sink: op <br />_______OBSERVATIONS AND CORRECTIVE ACTIONS <br />rV\\'yAo^ V __ylv > I UCJe'Y' <br />1 (/y-e. <br />Name: <br />Exp'Dy;SL./ 4^- <br />Received By/Title: <br />EHSP.O..IIS,: <br />EHD 16-24 (2n<ipg) 4/3/13 <br />Food Program Official Inspection Report <br />£s*4-ifirA /VtazA&f- Pate: <br />___________city: zipCode: <br />______ ___________ <br />Program Record: tTJif Of <br />Permit Posted Yes No <br />Phone: ^3?- <br />TimeOut: <br />Inspection Type: <br />Re-Inspection on or After: <br />Pag%ofq <br />FOOD PROGRAM 0IR CONTINUATION <br />Name of Facility: <br />Address: -j,-, £ <br />Yes No <br />cofyir.r L// <br />Warewashing <br />lother: