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SAN aJOAQUIN COUN' <br /> ya CNVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ��., a;p Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 6,41") z5LqL� ���, Date: /2 <br /> Address: rnCity: Zip Code: <br /> /n, <br /> Owner/Operator: aQ 4/1,4 <br /> . Telephone: <br /> Program Element: `0� Program Record: es- Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> ,. OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Iterr/Location„ , I Temperature Item J Location 'Temperature <br /> loll (l1(J�— 2 r! 110�z ice► Cf�Q �(v <br /> ------------ <br /> Food <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> -, �. pP... <br /> Name: Hand Sink: °F Chlorine: m Heat: `F <br /> Exp.Date: i arewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: _ <br /> ime in: Time Out: I R) Page of <br /> i <br /> EHD 16-24 (2n0 pg) 4/3113 FOOD PROGRAM OR CONTI UATION <br />