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qU,N <br /> ,oe .coG SAN JOAQUIN COUK <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sl4ov.orq/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: �_i <br /> Address: j qGj City: Zip Code: <br /> Owner/Operator: Telephone: <br /> enc;u C' v� pec <br /> Program Element: I Program Record: A1?39 <br /> Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: (i <br /> OBSERVATIONS AND CORRECTIVE ACTIONS Q <br /> V \ <br /> J <br /> wwl G� <br /> ' <br /> IN Get 2-- 04yw <br /> 1 r4 <br /> oLo <br /> /k <br /> 4 <br /> Ol <br /> WAA14 In UO dMN <br /> a - <br /> ao <br /> 10w 'k <br /> 1i k <br /> Item/Location Temperature Item/Location Temperature <br /> — --- ----- -- <br /> Food Safety Certification Facility Hot Water Temperature warewashing <br /> Name: Hand Sink: L1 of Chlorine: PPM Heat: 'F <br /> Exp.Date: ewashing Sink: 12;1 F Quat.Amm.: PPM other: 'F <br /> Received By/Title. <br /> EH Specialist: Phone: <br /> Time in: Time Out: LY Pa9 of p2 <br /> FOOD PROGRAM OIR CONTINUATION <br /> EHD 16-24 (2nd Pg) 413113 <br />