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oP411"Y c SAN JOAQUIN COUN I Y <br /> •� •.off <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �... :P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> '9C/FORD <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: &r��d S Q Ma r ri Date: _ D <br /> ddress: C 1 .S G City: b _tV Zip Code: 9 5.. <br /> Owner/Operator: ' V Telephone: ':31 Lt?_ 7&� <br /> Program Element: f Z$ Program Record: PROs 277 3O ' Inspection Type:�JO <br /> SBI80 Posted _(Yes No Permit Posted Yes ❑No Re-Inspection on or After: <br /> ,\ OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r <br /> in <br /> Lt s ri rt f a v Ccz Lc ro aLe <br /> f5a 6,0 ✓-0— r a- Lo <br /> We <br /> 1-t.v? d L r 4:5 a b S or b_o s 4-, cc.� <br /> L' <br /> Y V i <br /> Item/Location Temperature Item I Location T mpe ature Item 1 LocatiK Temperature <br /> �r L O <br /> Q <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: V/'0 r10k O Hand Sink: / of pt C I�ri�eQ /OOppm H of <br /> Exp.Date: _ /q r Wam2L!nk: 5 a of Quat.Amm.: �1_00 ppm Other: of <br /> Received By I Title: <br /> on on 01 <br /> EH Specialist: IU4 <br /> Phone: _ /7 �►� <br /> Time in: 'O , Time Out: j0<66Page f <br /> EHD 16-24(2^d pg) 419112 FOOD PROGRAM IRCONTINUATION <br />