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SAN JOAQUIN COUN . . <br /> � ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sipov.org/ehd <br /> �/FpR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: % t 3 ✓ Date: U I <br /> 1,S-- <br /> Address: r�,1�1 kc ;l, City: tVT� Zip Code: <br /> A2, <br /> r � <br /> Owner/Operator: -f T� l/w�� 1 Telephone: <br /> 1 5 —35 � <br /> Program Element: r„ 3 Program Record: U �3ri 2 Inspection Type: <br /> SB180 Posted YJ es ❑ Permit Posted Yes 0'11 Re-Inspection on or After: <br /> ERVATIONS AND CORRECTIVE ACTIONS <br /> SSM e U Ce Csf) - Sv �e, <br /> ll off 1�-e - <br /> h are, W <br /> Can,nrun rib rn wZn i s <br /> ff <br /> S TOT CjfN5i - U� n a <br /> I mQs� <br /> tter►tLoca ictn Temperature Item I Location Temperature <br /> ` mperature Warewashing v_ <br /> �.W ,e _ <br /> Name: Hand Sink: o f Chlorine _ppm IHeat -F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By I Title: �- <br /> � c. L <br /> EH Specialist: Phone: <br /> Time in: /7 \ Time Out: :"Ol Page 1 of <br /> EHD 16-24 (210 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />