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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.siQov.orq/ehd <br /> UFOR`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: A�, %AM600 Date: IfZ g• V <br /> Address: S T. City: Zip Code: cj.iZ06 <br /> Owner/Operator: Telephone: v <br /> ;3IMWev�G — �1�4 <br /> Program Element: Program Record: Inspection Type: r <br /> FB180 Posted a No Permit Posted a No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> \� ov <br /> l� <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: . Phone: <br /> Time in: t Time Out: 1 l,. Page of <br /> EHD 16-24 (2nd pg) 4/311b3 ` FOOD PROGRAM OIR CONTINUATION <br />