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SAN JOAQUIN COUN � <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4..-�_ ;4 Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> {IFt3'R� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r.e j h,r_ P Date: �__ 2 2 <br /> ddress: �2 {) G r0 t ,1 z 5 4 U A City: S �� Zip Code: <br /> Owner/Operator: W Telephone: <br /> Program Element: 16 rj I Program Record: S6 SO"ZS Inspection Type�"UnSu 4a4art <br /> SB180 Posted ❑Yes ❑ No Permit Posted 17 Yes ❑ No Re-Inspection on or After: <br /> 1 <br /> 1 <br /> .__._..._.- �•-«._,.n. _ . ,. _ OBSEFVATIONS,AND CORRECTIVE''ACTIONS. <br /> C)NOW !fA <br /> I r' I C. UJ h 0 Srn ooh Jeo /e a •,a( <br /> r f SUrfGcc, PG ;r, � W.'. � � e rl ryln a ; <br /> JA Cl Q( lhr .(.Ii Se14 CAAna- ttli �h <br /> eInry-10 CG n } #o o+ 5M0o41, Cie Cnc. bl <br /> $ trr �G+re . G0rreC � •n u)9-e �_' <br /> r,e Ce ; 1- k le , r. Gc <br /> r o v: a r % r, - _ - •.,Q d_ ykc,n <br /> CardS dcwr/ Y <br /> 7r lit i �S b r. S G use GY A ' / G G,r <br /> •{ oo( n 1{ r r nh 1 ki Ga yI vee 1l� T, C b- { <br /> /' II i 1{ <br /> 4 C n l c.C 4 G i iel-CS O r\d u • '.w,n s s r.ri; <br /> �, I 1 j <br /> jjj.11 OCC(Ar 401 7C. r,5 k C A ! <br /> itemlLocation _ Temperaturie Iterti I.NLocation Temperature Item. Location} Temperature <br /> 7r,Ae C re <br /> Food SafetyaCertiification� �, Facility HotVYater7egnperature r;WarewasWng - <br /> Name: Hand Sink: of Chlorine: ppm Heat: aF <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: ppm Other: 'F 1 <br /> Received By I Title: <br /> EH Specialist: y� Phone: <br /> Time in: j 1'1 <br /> 0 Time Out: -SS Page of/ <br /> EHD 1024(2"'pg) 4119112 FOOD PROGRAM 01R CONTINUATION 1 <br /> rt 1 <br />