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SAN JOAQUIN COUN <br /> ?, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �q<<FORa;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.or /gehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: s o <br /> iS 7}S C,riun tl cf hr, 9 33 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: a ^c <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> S..? r Ve G1 ✓ e a _ <br /> r • ; i'C i_(J ems. 1 / O i/i <br /> 1-4 GO YfrS 6 A a of b h_ <br /> e-, ILA in 6of rect 0 a'/ <br /> 1 WhoC Lj!xc-� h 1Z On el S:,IK is /v e <br /> Item/Location '.Temperature item(,Location j Temperature <br /> rf'a v✓) �s' l' <br /> Food Safety <br /> Certification Facility Hot water Temperature --- - warewashing 4 � Ra��.,�: <br /> _._.io _ - <br /> Name: Hand Sink: "F Chlorine: m Heat. of <br /> Exp.Date: ,16 arewashing Sink: °F ouat. Amm.: 1 ppm Other. of <br /> Received By/Title: <br /> EH Specialist: X16/ V I Phone: <br /> Time in: / Time Out: 1 .33 <br /> J 7 J 7 Pageaof= <br /> EHD 16-24(2a0 pg)4/3113 FOOD PROGRAM OR CONTINUATION <br />