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SAN JOAQUIN COLIN' <br /> '•OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s*gov.org/ehd <br /> ��FORl� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: j> ;',k,CL Date: <br /> Address: ` City: Zip Code: <br /> Owner/Operator: ` Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> B180 Posted es ❑ Rermit Posted es ❑ I Re-Inspection on or After: <br /> v OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 'v�.e, �. GZv't i. ��w�F GL d���Gti�v�-�'• _ <br /> ev w <br /> y` fil.Ltyk <br /> i vVttiNh <br /> � -1c <br /> Food Safety Certification „y , Facility Hot Water Te nature War' <br /> we3 <br /> Name: til /61 Hand Sink: of [Quat. <br /> hlorine: ppm Heat: of <br /> Y <br /> Exp.Date: /1 arewashing Sink: of Amm.: ppm ther: of <br /> Received By/Title: I I <br /> EH Specialist: Phone: Ef <br /> Time in: I iTime Out: Page�of' <br /> EHD 16-24 (21 pg) 4,!3/13 FOOD PROGRAM OIR CONTINUATION <br />