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SAN JOAQUIN COU <br /> 0•,. ...... C <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> cq.: -• ;P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 41 Date: ,;L)• ;, <br /> Address: t City: - Zip Code: <br /> Owner/Operator: /f � ' Telephone:. <br /> Program Element: Program Record: Inspection Type: ,y ' <br /> SB180 Posted i Yes F. No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 <br /> e/ti� t� -e-WI .{•.- 4614..' gleet I <br /> / �IVtitil'.l- /" I.C.''iv'{f'fxf,yJ•t�. C-l� /1 ` �''tj i.L{� <br /> Y - <br /> Xilt' t', , CLQ 1111_C0` •�`trgQ' 7l, a2c n6— <br /> r C(1•�itt'-Cx �' ' ��L'_ �f/�Jt ;%mow+-'L{ �,•"1�+- � C.C�Gd�, � ��'d1'Lt,( <br /> ,It 2-u Z 40, 1,-20"F atG't <br /> � ,dl Lt.s t� <br /> Item/Location Temperature Item i Location Temperature ( Item 1 Location ,y Temperature, <br /> Food Safety Certifction Facility Hat Water Temperature Warewashing <br /> Name: 1/ ''/ Hand Sink: / o Chlorine: PPM 'Heat <br /> Exp.Date: l s arewashing Sink: l d of Quat.Amm.: ppm iOther: of <br /> Received By/Title: �/j / K_ 0 ,/$ <br /> EH Specialist: Phone:' <br /> Time in: Time Out: Page/ of <br /> EHD 16-24 (2n°pg) 11/2109 V FOOD PROGRAM OR CONTINUATION <br />