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SAN JOAQUIN COUN i Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.(209)464-0138 Web:www.segov.org/ehd <br /> <<POR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: >1 � ' 3612 y Date: .1.2 _ cl <br /> Address: n City: Zip Code: <br /> 93 11 S4- l a <br /> Owner/Operator: 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 /> ............ Us._ < t,cf. mo 1/,i <br /> _ L ...._.........._._.._._.._sem C�� n 0Z L lPS h�- t b ; l G� � 02 �-/�'► I�-- ��.._ .�'.�r- - <br /> dp <br /> 1 I C M 3o; / )24 pe,r 0^ <br /> G ' S 1 a� <br /> ItemlLocation + Temperature Item I Location { Temperature <br /> I <br /> Food Safety Certification I Fa H Water Temperature Warewashing <br /> Name: Hand Sink: `F Chlorine: PPM (Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: PPM Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: 5'v Page of , <br /> EHD 16-24 (2°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />