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SAN JOAQUIN COU. <br /> ENVIRONMENTAL HEALTH DEPARTMENT —F <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ctlPda Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sioov.ora/ehd ` <br /> . ... :..�;p u . 20 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: O-` Date: 3— <br /> ddress: 2q C City: Zip Code: o) 33b <br /> wnerlOperator. �-1;7 Telephone: y 3\0— 9610 <br /> �(1 b SO <br /> Program Element: \ Z Program Re rd: \ Inspection Type: 17 <br /> 8180 Posted Yes 0 Remit Posted Yes C I Re-Inspection on or After: ,�-v <br /> D CORRECTIVE ACTIONS <br /> 07\_e <br /> c 1 A� l � 0n <br /> 2 OL er <br /> IF `M 5 F r <br /> JL f <br /> C Z>� <br /> tion' Temperature x Item'ltocation :_ <br /> lirt—Y 11 <br /> -- acility._H_ot.Water Tem_ perature ' <br /> Name: e and Sink: 7 r1 =F hlorine: - ppm Heat 'F <br /> Exp.Date: _ 1 a washing Sink: �-[."F uat.Amm.: PPM ther: �F <br /> Received By I Title: i►-iif � � <br /> EH Specialist: - 1 Phone: '4 b _0 3 Y� <br /> D` Yl _ <br /> Time in: I \ Time Out: �. G Page.?f <br /> cHD 1624(2n0 pg) 413113 IFOOD PROGRAM OIR CONTINUATION <br />