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PQu�" SAN JOAQUIN COU. t <br /> 4 'X ENVIRONMENTAL HEALTH DEPARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ��...•......a�P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siQov.or /q ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: I _ <br /> Address: Y Q Gt City: c_l i� •�� Zip Code: o15�O-7 <br /> Owner/Operator: ceTelephone: <br /> Program Element: �O•L� Program Record: P 2 Ol X033 Inspection Type: <br /> SB180 Posted Yes No Permit Posted'(Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS- <br /> -------- <br /> Item/Locattonemperature� Y Item%Location Telilserafure <br /> Pood`Safe If C;3bon f.r _' Facia Hpt 1Nater emperature -- 1lflarewashm :: <br /> �h!.� .., <br /> Name: HamiId Si k: D S T100 of Chlorine: ppm Heat: -- — of <br /> � 144Exp.Date: Sink: /:2CpF Ouat.Amm.: ppm Other: of <br /> Received By/Title: ��GL 4 L h7 <br /> , <br /> EH Specialist: Phone: <br /> —._............_._.....-- <br /> Time in: ;2,5 <br /> (5 Time Out: / Page,.,,of.:), <br /> EHD 16-24 (2^6 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />