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C <br /> SAN JOAQUIN COUNTY <br /> y <br /> r, ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.so Ov.Org/ehd T1�p <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 'ate Q�q Date: t 0 <br /> Address: 2 SJV n City:T�rnc Zip Code: 9 S �� <br /> Owner/Operator: S T P" r _ Telephone: <br /> Program Element: Program Record: S2 �(ob Inspection Type: `� ^e <br /> � <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �L � t•• .___ vJ � � <br /> rtV <br /> . Locahon Temperature ..._„ Item Location Temperature <br /> CA�Skjzl �- <br /> � <br /> VVarewashng <br /> Name: ,� and Sink: of hlorine: PPM Heat: 'F <br /> Exp.Date: arewashing Sink: of uat.Amm.: PPM Other: of <br /> Received By/Title: Mo <br /> EH Specialist: `• ` \ _ Phone: 'A q O <br /> Time in: V Time Out: 1 �� Page_-Af z <br /> 2:3o <br /> EHD 16.24 (2w pg) 4/N13 FOOD PROGRAM OIR CONTINUATION <br />