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,O�qu1N. o <br /> SAN JOAQUIN COUNTY <br /> Q .x <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 98205-6232 <br /> �0 Telephone: (209) 468-3420 Fax: (209)484-0138 Web:www.si-qov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name o7E ,� ; [7ddresDate: �,City: �.� Zip Code:Dwnerlra �` - 1� �� 1r— <br /> Program lenient: CTelephone: l�,00 Program Record: Cocom i <br /> inspection Type: CC��1._U1 n t <br /> 5Bi60 Posted Yes t3 Rermit Posted <br /> C]Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE.ACTIONS <br /> Cis lCiiCit S�� = T uS �n e 1 C.� . C0Cy cactiGl�2S <br /> i n itl-2, bar✓l�, <br /> d.e0o a6A1+1+ wcy--VoC awe , e <br /> t t� SU w,r i�e c o SFS c-i GA 1_ .es�C s epi p-n— <br /> _ �1-r v t lQ Se7 1 6- f - �C s2t WCs Qy 1��ryec <br /> was of ,�CksW j\ <br /> _ �h� �u�� �a��2a 1-�-P-x F .. tz� �� ►�e bin . caw nor s�-es <br /> Item/Location 'Temperature item I Location Terrtperature <br /> Food Safety Certification I FacilityFlat t+Jater Temperature Wamwashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Dxte: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By 1 Title: /7 / <br /> EH Specialist: Phone: <br /> Time in: ; 0 Time Out: U ft Page oft <br /> EHD 16-24 (2n1 pg) 413/13 1 FOOD PROGRAM OIR CONTINUEATION <br />