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saG SAN JOAQUIN COUI ' <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> Iq: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> LIFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ) Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: T 71- `-)-/ Telephone: 7 <br /> Program Element: /,7 ogram Record: /� Inspection Type: <br /> B180 Posted t` / Yes ❑ Permit Posted l Yes ❑ I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ✓J Yl'vGv <br /> v� <br /> A G vi <br /> Gl t4_1 C <br /> OlM a -� cUt Ani <br /> P11 V.747 <br /> Ci(l /til, W l a-CP 1 <br /> vv - p - <br /> Item/Location ! rature <br /> gy <br /> E; <br /> � acility Hot Water Temperature Warewashing <br /> Name: �1 h L i <br /> la <br /> d Sink: o f Chlorine: ppm Heat: F <br /> Exp. Date: ewashing Sin . / of Quat.Amm.: ppm they: of <br /> Received By/Title: i <br /> EH Specialist: Phone: <br /> Time in: 1 r Time Out: Page of <br /> EHD 16-24(21 pg) 41313 FOOD PROGRAM OR CONTINUATION <br />