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ff SAN JOAQUIN COUNO <br /> a'�a'Fp <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> °dY/Faa�P Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sioov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> ame of Facility: _ Date: <br /> ddress: h City: Zip Code: <br /> wner/Operator. V_ le Telephone: .S� ` <br /> Program Element: Program Record: Lly—q -703 Inspection Type: � <br /> 8180 Posted !I Yes 71Rermit Posted � _e1s ❑ IV Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ✓W U <br /> 01/1. <br /> ltemgacaGon , , Temperature Item/Location Temperature..; <br /> _ .. <br /> got <br /> 19- <br /> Food Safet Certifwation` Facility Hot Water "'.. .. -�.. <br /> y -- � - y Temperature ..v <br /> Name: I!Hand Sink: of Chlorine: ppm eat: OF <br /> i <br /> Exp.Date: Warewashing Sink: -' n of Quat.Amm.: ppm Other. aF <br /> Received By I Title:Y d- <br /> EH Specialist: !� Phone: <br /> ime in: ' <br /> Time Out: _ Page)v f OL <br /> EHD 16-24 (2"pg) 4/3113 FOOD PROGRAM ORCONTINUATION <br />