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SAN JOAQUIN COUN� <br /> p .. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: e� � Date: t <br /> ddress: h City: Zip Code: <br /> Cl_ 1 e <br /> Owner/Operator: C Telephone: <br /> Program Element: / rogram Record: Inspection Type: <br /> 6180 Posted ` es ❑ Permit Posted es ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 17I <br /> �. <br /> Ed <br /> ftiK,wj_( a —mac,► l�v� <br /> c, -d v"- vv�Ao W-4 <br /> ,Le <br /> -- <br /> L <br /> J- V14 / <br /> Food Safety CetficatioFacility Mot Nater Temperature Warewashing <br /> _ _. j. <br /> Name: ,+ l Hand Sink: y 3 . r� of hlorine: ppm ''Heat: F <br /> Exp.Date: ' arewashing Sink:�l��� of Quat.Amm.: ppm Other: F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: C Time Out: ( Page -of <br /> L., <br /> EHD 16-24 (2n1 pg) 4(3'13 FOOD PROGRAM OIR CONTINUATION <br />