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SAN JOAQUIN COUN <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> to: I X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si.gov.org/ehd <br /> �1FOA <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ►3 2 J k SS Date: /_ /2-IS <br /> Address: 16 9U S r I c; ,I City: L rA I h r o Zip Code: <br /> 9$336 <br /> Owner/Operator: Telephone: R's k, 9 7 2 <br /> Program Element: Program Record: Inspection Type: pC ieNS 42e 0 �^ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 0) Cover C ra c 'Ve'al r 1U Ce i .I / w.ee.._K.__.._.__..._.__ <br /> .70 . I -w o n S rn c.11 reg.c h •1, ------- C/c ti _.1 <br /> Item/Location ? Temperature Item/Location Temperature. <br /> ........... <br /> ----- - — -- ---- --I-- --- - - ........ ............... 1- <br /> -------- _. <br /> Food Safety Certification Faciii#y Ffa#Water Temperature Warewashing <br /> Name: Hand Sink: °F Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: (Q 3 Time Out: v0 V Page o� <br /> EHD 16-24 (2^ pg) 4013 FOOD PROGRAM OR CONTINUATION <br />