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ogAH!N.,F SAN aJOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c•., P. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siciov.org/ehd <br /> 'rCI FORA <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: '/t p` tt O r7 Zjq Date: <br /> Address: O V�� . 1 • Zip Code: <br /> Owner/Operator, h Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> All IF40t <br /> rD PA V1 7 <br /> c <br /> WITI,( <br /> e = � i�S /► <br /> Item/Location Temperature Item l Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F [Chlnnoe: ppm Heat: J'F <br /> Exp.Date: arewashing Sink: 'F uat.Amm.: PPM 11 Other: <br /> Received By/Title: <br /> Q �- <br /> EH Specialist: Phone: <br /> Time in: _ t--•� Time Out: . © Z Page of <br /> EHD 1G24 (2^ pg) 4/3113 �1 OOD PROGRAM OIR CONTINUATION <br />