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,.. ..oG SAN JOAQUIN COUN" <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sl9ov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: c piJ Date: l <br /> Address: ' /A) H-a vy�L' ,nom Q /� City: Zip Code: <br /> Owner/Operat r. 1� l _C! r /�/149p1 Telephone: <br /> Program Element: 1 a Pr gram Record: l / Inspection Type: 4t l,t <br /> I r <br /> K8-0posted Yes F1 Permit Posted Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> LuGLIA✓✓�r, -CGvv� (y�^ Z <br /> 0(11� _;UX t, P14 AAe <br /> Gt+� - <br /> 1 -) - <br /> ¢ Gc <br /> Item/Location Temperature Item/L.ocatlon ``l' ' ` ••e` - Temperature <br /> Warewashing <br /> Name: Hand Sink: of hlorine: PPm_.Heat: F <br /> - --- -- <br /> Exp. Date: arewashing Sink: oQuat.Amm.: ppm Other-- <br /> F of <br /> Received By/Title. <br /> EH Specialist: Phone: _ <br /> Time in: Time Out: t�7� Page of <br /> EHD 1624(2^d pg) 4/3113 , FOOD PROGRAM OR CONTINUATION <br />