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oaa"l" SAN JOAQUIN COUNTY <br /> �.•-�'.CSG <br /> z. 2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:vvwv,,.sjgov.or./q el)d <br /> 4Likbvi <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ( (� ��� sf9'I Date: I_• J iii! 4 <br /> Address: !� P/ City: �'_. `> ,; .' .•`,t Zip Code: <br /> Owner/Operator: , Telephone: <br /> Program Element: Program Record: Inspection Type: :t <br /> S13180 Posted Yes i_i No Permit Posted [_I Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> MWr r <br /> -_ 1 lw&4e X17 t <br /> tj <br /> Item/Locationperature Item I Location Temperature Item 1 Location Temperature <br /> Tem <br /> z ✓ �, r I • ,��l . <br /> Food Safety Certification Facility Hot Vlater Temperature Warewashing <br /> Name: Hand Sink: `F Chlorine: ppm Heat: `F <br /> Exp.Date: A Warewashing Sink: j` {) of Quat.Amm.: ppm Other. 'F <br /> Received By I Title ! i! <br /> EH Specialist: _ _ - _-- Phone: ` + <br /> Time in: Time OLA: Pagev of "z <br /> EH6 16-24(2^'pg) 419112 FOOD PROOrRAM CiR CONTI UAT101 <br />