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SAN JOAQUIN COUNTY <br /> �: .. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 488-3420 Fax: (209)464-0138 Web:www.sjgov.oM/ehd <br /> L�FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT L yca,:z� <br /> Name of Facility: l H -Date: q_S—� <br /> 2- <br /> ddress: .Zy y ` city: r _ Zip Code: c:� <br /> Owner/Operator: -1(\ Telephone: <br /> Program Element: -vtogram Record: t �•Z� Inspection Type: <br /> SB180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> CCS <br /> der. aur <br /> - - v f�►`ter: ,� <br /> S 1 C G < <br /> A1 j G <br /> �r ' s lam <br /> Item/Location Temperature Item I Location Temperature item I Location Temperature <br /> Food Safety Certification Facility Hot water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: of 4uat.Amm.: ppm Other: of <br /> Received By 1 Title: <br /> Eli Specialist: Phone: <br /> Time in: l !� Time Out: v Ci Pagel of <br /> EH 16-24 (2^ pg) 419112 �.! FOOD PROGRAM OIR CONTINUATION <br />