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SAN JOAQUIN COU Y <br /> p .. <br /> �O.'��.COG <br /> .X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility 1,\_ Date: I S <br /> Address:-'-" City: �•J�7;� Zip Code: <br /> Owner/Operator ut— Telephone: <br /> Program Element: r , / G Program Record: �� Inspection Type: <br /> FffMOPosted l•( t Yes ❑ Permit Posted ❑Yes ❑t Re-Inspection on or After: <br /> OBSERVA T IONS AND CORRECTIVE ACTIONS <br /> S 1�t <br /> ,1 A <br /> two <br /> �fic.e pcf��wwt,�vL vc� <br /> Oq <br /> CA - <br /> CI t, VIA ate- OVA" -- — U <br /> C ,e t_ Gu"Pt- 6"Wt - F <br /> U U <br /> p <br /> 0_�- <br /> VL00A1/* 3 - <br /> 1� - <br /> A) <br /> Item/Locati Item/Location Temperature' <br /> _.._: W_.... _T .. ._.. -. <br /> ✓ 3—moi <br /> Food Safetyettifie8tion Facility Hot Water Temperature�i VNarewashing <br /> — _ _ - <br /> Name: Hand Sink: of Chlorine: ppm �th <br /> : of <br /> V'V 1 <br /> Exp.Date: arewashing Sink: of Quat. Amm.: ppmr: of <br /> l <br /> Received By/Title: <br /> EH Specialist: Phone: /� <br /> Time in: Time Out: l!/ i Page of <br /> EHD 16-24 (2nl pg) 413/13 FOOD PROGRAM OR CO TINUATION <br />