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SAN JOAQUIN COUPcc: ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ __ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.., ..�P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s*gov.org/ehd <br /> ��Foaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i Date: / <br /> Address: tt (f � _ City: Zip Code: <br /> Owner/Operator: IV Telephone: <br /> Program Element: Pro am Record: Inspection Type: <br /> 6180 Posted Yes ❑ Rermit Posted ❑Yes I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> of <br /> Itern. Location Temperature <br /> f D <br /> Food Safety Certification Facility Hot Water Temperat rewashing <br /> Name: I W1,: a ,1 Hand Sink: 1 ofChlorine: ppm Heat: of <br /> Exp.Date: Il C qo`� ar ashi mk:1 o f Quat.Amm.: ppm Other: o f <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Timein: Time Out: lY Page f <br /> =HD 16-24 (21 pg) 41313 FOOD PROGRAM OIR CONTINUATION <br />