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SAN JOAQUIN COUN <br /> p .. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s*gov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility:ddress: 7 Date: <br /> II�� I u :�� -�c!� s <br /> 1 C' ! I L; re City: !' c Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: Y)c yJ <br /> 6180 Posted es F1Rermit Posted ❑Yes L, Re-Inspection on or After: /� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I i <br /> Item/Location Temperature Item/Location Temperature <br /> i <br /> Food Safety Certification Facility Hot Water Temperature ii Warewashing <br /> Name: /y I lland Sink: rvU of Chlorine: ppm Heat: of <br /> -- - ¢ <br /> - - - <br /> Exp. Date: m G Sink: ` �; of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: y J16d' <br /> Time in: :Z Time Out: u p Page of <br /> 7 <br /> EHD 16-24 (2^d pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />