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SAN JOAQUIN COUNT'. <br /> 'o ,..........c <br /> _ y ENVIRONMENTAL HEALTH DEPAI,, i'MENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: � ,Y •) Date: L <br /> 5O <br /> Address: 1 City: Zip Code:wa t�� sfi� 062�� <br /> Owner/Operator: SAA 7�,-�— \(,4 0-1D � C_ Telephone: <br /> C�f <br /> Program Element: t CProgram Record: _(' I "-, G 2� Inspection Type: - <br /> SB180 Posted ❑Yes ❑ Rermit Posted C C Yes ❑t Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> F�tlyi�Cafi� �r�neL-� �XC��fi <br /> -w "aQ ocu ora Cate <br /> Item/Location Temperature I fecteratial ; <br /> • <br /> I <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> _ _ _ <br /> Name: Hand Sink: F iChlorine: ppm (Heat: °F <br /> Exp.Date: Warewashing Sink: `F Quat. Amm.: ppm then. F <br /> Received By/Title: <br /> EH Specialist: 04 !•� Phone: (ICA �6G - �4i <br /> ime in: Time Out: 7J Page( of <br /> X1'2 l <br /> EHD 16-24 (2ndpg) 43/13 FOOD PROGRAM OIR CONTINUATION <br />