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SAN JOAQUIN COUN- <br /> � •.off <br /> X ENVIRONMENTAL HEALTH DENARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ��FORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: p i I •� , C' 1- �••t C� }�, ' _ I Date: <br /> Address: 35M c•uq -o h t"` City: S �V•�Jr 1 Zip Code: ry t <br /> Owner/Operator: r v-vii nC/t–�f�IP' )o i'I wa W Telephone: p– <br /> po WG <br /> Program Element: ) b�1 Program Record: b U��. `1� Inspection Type: <br /> V918-0 Posted ❑Yes rmit Posted T` es ❑1 Re-Inspection on or After: tM�' <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I S" - glcl& o� 1h -4e-ht-IL <br /> ora P-eG I(- ( e'o-- <br /> Temperature Item/Location Temperature <br /> I <br /> Food Safety Certifica <br /> tion e ._ t=aoility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppmOther: of <br /> Received By/Title: J � <br /> EH Specialist: Phone: r a <br /> ime in: Time Out: • 1V Page of <br /> EHD 1624 (2^4 pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />