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°"'" SAN JOAQUIN COUN <br /> ;, <br /> �Q. <br /> Za 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 /> 4�,FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: e 1 0 M , ( 0 h =G UC � 4 0T)AL L '_-cl V + Date: <br /> ddress: Q E. 11-„ i City: ' �j1 Zip Code: Q O <br /> Owner/Operator: M 0 1 v1 Telephone:2I C6 _30 S-6 <br /> Program Element: Program Record: Inspection Type: 17 - \91r.�{i cm <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes F1 Re-Inspection on or After: 1` <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - - V 10 a Ur S cv r(O CA6 <br /> 0At _ SSW(2- bXM it <br /> Item/Location T Temperature �� s ^ item/Location Temperature <br /> Facility Hot Water Temperature Warewashing <br /> Name: HandSmk. (,L of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Am M.: ppm Other: °F <br /> Received By!Title:! ` <br /> EH Specialist: io Phone: <br /> Time in: ` Time Out: _val J Page of <br /> EHD 16-24 (2"lpg) 413/13 ✓ FOOD PROGRAM OR CONTINUATION <br />