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SAN JOAQUIN CiOUi ' <br /> Q` 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 /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: "A06X <br /> Date: <br /> Address: -3'0L(,,, m �u City: `1�, 1,� Zip Code: ;L_,O <br /> Owner/Operator: S,� f ./�► CITU 7� Telephone: y,--7__7 1 <br /> Program Element: �D Program Record: 0 <br /> 5 a! 3 Inspection Type: <br /> B180 Posted >I Yes ❑ Rermit Posted x7 Yes ❑1 Re-Inspection on or After: f� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � - Item/Location Temperature Item Location Temperature <br /> Fooi Safet Cerfiifieatior Facility Hot Water Temperature Warswashinfl <br /> Name: :Hand Sink: of Chlorine: ppm 'Heat: of <br /> Exp.Date: Sink: 7 of uat.Amm.: ppm !!Other: of <br /> Received By I Tit e: ` <br /> EH Specialist: OkAl� 6.e L4," Phone: 01 5 —,?.g I) <br /> Time in: I�. C,� Time Out: Page of <br /> EHD 16-24(2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />