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o Wtv o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..• a�P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.si.gov.org/ehd <br /> ��Foa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 7, ' L.. Date: <br /> Address: , 0 e C 2 I Z City: Zip Code: Q <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS -40 <br /> C.D 5 2 S <br /> kr <br /> .\XA <br /> ." - 2A:) t -C—a <br /> S e <br /> Item/Location Temperature Item/Location Temperature <br /> I - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Dat Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Tt <br /> EH Specialist: 1„ Phone: 'I ko Vt� .-0 2 3o <br /> 1 <br /> Time in: ' ` \ Time Out: I t ' �7 J Page)of <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />