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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. ;P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 0 � Date: ` -r t <br /> Address: �W { (�4"� City: p - Zip Code: 14� v <br /> Owner/Operator: 1 I F'l Telephone: 7 <br /> Program Element: �(„-s�P_ Program Record: /t h r/ Inspection Type: <br /> V <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �G q U 3 i <br /> db 1 Lot, d N ' <br /> p <br /> o►n S Ae <br /> • L "� 156v� CAAc - / <br /> m/L catt Temperature Item!Locatio emperature <br /> ificatio I Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: 4 Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: - <br /> EH Specialist: .7 Phone: wq - �1,, 0'zvs <br /> Time in: Time Out: T/ Page of <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />