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°. SAN .10AQUIN COUN1 ._ <br /> '0 p..........0 <br /> .OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �;...., ..a:P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:vvww.sigov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J Date: <br /> Address: a / City: r t i Zip Code: / <br /> Owner/Operator: `i ` Telephone: <br /> 1 4,0k- 49G-3aly <br /> Program Element: CrL Program Record: S CG �qE� Inspection Type: CCnS G <br /> V91—Fo <br /> Posted ❑Yes ❑ Permit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> .E. OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L <br /> o v; jt U W n ntrl e <br /> 1& 3 <br /> 0. v jo e r fo; 4-0 .� G l s 6"/1 (e a 1'S h G ve b PP n A:d <br /> Item/Locationem perature•`' <br /> 7 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> e: Hand Sink: of !Chlorine: ppm Heat: °F <br /> Date: Warewashing Sink: of �Quat.Amm.: ppm Other: of <br /> ved By/Title: - �. <br /> )ecialist: _ Phone: <br /> n: Time Out: }r^0 Z Page of / <br /> A (2n"pg) 413/13 0 FOOD PROGRAM OR CONTINUATION <br />