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SAN JOAQUIN COUNTY <br /> G ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> :p Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of FacilityDate: —t <br /> Address: City : Zip Code: pl S <br /> Owner/Operator. Telephone: 3 <br /> Program Element: Program Record: 1 l,1 �2 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes l No Re-inspection on or After: <br /> l� IAVAT'IO AND CORRECTIVE APTIIONS <br /> AAA <br /> lc� s� <br /> S <br /> S - <br /> 2 �?c � � 2- 2-6- C T7C <br /> rixnft tjaair em era <br /> tore 13ettt etltperturiz <br /> 5 c- 1-AC)►— sc..1=• __ OL <br /> l�b <br /> A1 <br /> 3—S 2- <br /> Foodsafe! Certkf tion r` Cli"vt waater TemperatureYVare ash.i _ <br /> Name: _ Hand Sink: aF Chlorine: <br /> l� Ppm Heat: 'F <br /> Exp. Date: �Z 2� ar ashin Sink: 1 of Ouat.Amm.: PPM ther: of <br /> Received By 1 Title: C'► <br /> - cejI i, kch <br /> EH Specialist: `�- � .- � Ph e: <br /> Time in w�Y'~ fine Out- „i Page f <br /> EHD 16-24 (2"pg) 4!3113 FOOD PROGRAM OIR CONTINUATCN <br />