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SAN JOAQUIN COUP. <br /> .y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> - = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s*gov.org/ehd <br /> L�FORt•� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 CA L41 SP— -4+- Cj -17-7,',, 1 Date: �!/I�, I <br /> Address: 12-A 4 U S ts. �.}- City: 5- �r+.:zym Zip Code: ,_pu <br /> Owner/Operator: "Ic r•1')-v� ,. �n n� Telephone:0646__v7gcle>. <br /> Program Element: (p�) Vl Program 1 1R`eccor : Inspection Type:v17a1 <br /> 6180 Posted 0 Yes ❑ Permit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> oc� S ACve� oT)\ 'mi \Q- n i S <br /> NN U �;n CU u-e `xin t�_ S <br /> Item/Lt <br /> ocation I Temperature Item 1 Location Temperature <br /> �_ <br /> I <br /> 4n 1facility Hot water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: PPM (Heat: of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: PPM (Other: of <br /> Received By/Title: I <br /> EH Specialist: Phone: q_ _ <br /> Time in: �O Time Out: = ,} Page ^of <br /> EHD 16-24 (2n°pg) 4/3113 `T FOOD PROGRAM OIR CONTINUATION' <br />