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,�P •.�oa SAN JOAQUIN COI. Y <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> J <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: `5 `n �O M7-1�O 'i 1 Date: 12 <br /> Address: 2 qC onil City: c Zip Code: Cl SZ <br /> Owner/Operator: N\�aJ � y ; � J Telephone: ClZ 2— 3 5 <br /> Program Element: t b 3!S Program Record: 5 2 2 1 -� Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> t �- <br /> l e sQ IM ':A - - <br /> to ^1315 --- --- -- ----- <br /> Item/Location Temperature Item/Location Temperature <br /> — rl t- <br /> S <br /> k-1 0E <br /> Facility Hat Water Temperature Vtitarewashrng <br /> _ .,- <br /> Name: fir`C Hand Sink: I'2++ __ IF Chlorine ppm Heat: of <br /> Exp.Date: 1 1_1 Q_ ZO ar washing Sink: F Quat. Amm.: m Other: of <br /> Received By/Title: Ick - <br /> EH Specialist: \ - Phone: 14 <br /> Time in: 2 3Q Time Out: + LAS Page. of <br /> EHD 16.24 (2ndpg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />