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SAN JOAQUIN COUN'1 - <br /> � a <br /> .Za ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.. iP Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s*gov.org/ehd <br /> L:j ig a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,, -pry) (7(le . 6 Date: � zL <br /> Address: —��i t 1 City: �I,� r Zip Code: <br /> Owner/Operator: Dq�`11"� r i -:Z7i Telephone: , <br /> Program Element: �J Program Record: 4C 0'3 C/ Inspection Type: 0 <br /> B180 Posted ❑Yes ❑ Rermit Posted ❑Yes [II f Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L 1 --# <br /> Ala V 10 _ S 0 DV <br /> ItemlLocation Temperature ! Item/Location <br /> reWarewashing <br /> Name: and Sink: aF Chlorine: ppm (Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other. of <br /> Received By/Title: C, <br /> � Y 1 <br /> EH Specialist: Phone: L 6`, `� <br /> �S <br /> ime in: C 1_ u Time Out: � Page of <br /> EHD 16-24 (2n0 pg) 413113 T FOOD PROGRAM OIR CONTINUATION <br />