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SAN JOAQUIN COUNS <br /> Z NVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.siaov.orD/ehd <br /> 4ClPOA� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - Date: 17- 17,,1113 <br /> Address: ).)dl City: 50* (67(/ <br /> Zip Code: <br /> Owner/Operator: t/' L Telephone: 31qg:24 -7 <br /> Program Element: V Program Record: Inspection Type: <br /> lk <br /> SB180 Posted Yes No Permit Posted �.: es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a <br /> 2 U - <br /> iv r l O(W <br /> 3 <br /> NA U <br /> NArr <br /> 0 (ci L P< <br /> IMM-4tern/Location 1 1. Temperature <br /> KR-dmr ,�y L <br /> 6-t ' 114av4 f2lif <br /> —v AAMI&A4 I 6jiA v <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine; ppm Heat; -F <br /> Exp. Date: WarewashingSink: oP Ouat. Amm.: ppm Other. of <br /> ESpecialist: <br /> le: ._ - j ,�/L � . Phone:Time Out: ''1 t O Page of <br /> EHD 16-24 (2-pg)4/313 V FOOD PROGRAM OIR CONTINUATION <br />