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SAN JOAQUIN COUR <br /> •0G <br /> _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> /FORi� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f Date: j <br /> k� C t7 <br /> Address: (:; City: Zip Code: t <br /> Owner/Operator: /, p 11 Telephone: <br /> Program Element: //n/t Program Record: O V„) Inspection Type: <br /> B180 Posted (Y Yes ❑ Rermit Posted Y sIII Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l- _ a� <br /> VV (�-4 C <br /> c <br /> / `,_`C 4t <br /> ,t.-r a ✓1-+-v ti <br /> Gt P <br /> (WOLK 4- i <br /> �o c -aA"L <br /> .{'l"... 1 �+��”�� ,G�1 1 �.�;';` �ir1,,7, 'IF ,tet y�1 r' I <br /> Facility Hot afar emperatureWarewashing <br /> Name: Hand Sink: of ri _... - <br /> f C, � f Chlone: ppm Heat: �F <br /> Exp.Date: Warewashing Sink: F Quat.Amm.: ppm �Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime in: / <br /> 1; C Time Out: Page of <br /> l V 1vw, <br /> EHD 16-24 (2n°pg) 4'3/13 FOOD PROGRAM OIR CONTINUATION <br />