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Pqu fnf - <br /> �R• .eoG <br /> SAN JOAQUIN COUNTY <br /> y _ X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4`ij o4 P Telephone:(209) 488-3420 Fax: (209) 464-0138 Web:www.siaoy.or./gehd <br /> FOOD PROGRAM[ OFFICIAL INSPECTION REPORT <br /> [Address- <br /> me of Facility: �r f C k M <br /> IG G ' 1 1. r !late- a City: Zip Code:YL <br /> ner/Operator: ` f f7 Telephone:Qarf7�ogram Element: 6aD Program Record: l of180 Posted ❑Yes ❑ No C0� Inspection Type: <br /> Permit Posted C7 Yes ❑No lXIYI <br /> Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> !rl 1 / D- l 5 a h o <br /> ��11L d z5z ?4 aC dG k C W T C2r.� <br /> - / CC <br /> � - <br /> s <br /> L,4-G 4 1c <br /> n d n GinOW <br /> Q2d S <br /> Item/Location Temperature Item!Location Temperature <br /> 'Z_e_�\ X _3A")r <br /> r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: r Hand Sink: D of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2n�pg) 413113 F00D PROGRAM OIR CONTINUATION <br />