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SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0: 4 A <br /> 111444_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. -.a�P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of FacilityDate: <br /> : ^��L� � � } �-�� � S <br /> Address: i n, City: 4' Zip Code: <br /> Owner/Operator: wv 4 (NTelephone: <br /> !2 Alnm <br /> Program Element: Pro am Rec / !��3aZ Inspection Type: <br /> 8180 Posted ❑Yes ❑ Rermit Posted El Yes•YCes ❑( Re-Inspection on or After: <br /> OBSERV4TIONS AND CORRECTIVE ACTIONS <br /> ooc <br /> 2 ✓I.�1.tit de Lt- izzl <br /> S' vyv otn� aif-e <br /> L �k�ivr•� ryv� IX/Lfi <br /> - Item/Locations Temperature emperature <br /> IWAQ-/ V V "_/ <br /> dA A <br /> vvw I lP <br /> ,:• Facility Hot Water Temperature ° <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> ti <br /> EH Specialist: Phone: — <br /> ime in: r C Time Out: Page of <br /> EHD 16-24 (20°pg) 4;3/13 FOOD PROGRAM OR CONTINUATION <br />