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SAN JOAQUIN COUN . '7 > <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.sigov.orgl d <br /> �/FORD <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J. d czrDate: l <br /> 2 Z /lot <br /> Address: f City: Zip Code: <br /> Owner/Operator: V �(1 Telephone: iLo f _ I L <br /> Program Element: Program Record: b { d Inspection Type: <br /> mle <br /> IS 6180 Posted ❑Yes ❑ Rermit Posted [-.Yes ❑I Re- ection on or After: <br /> s MW OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Z `01 <br /> "ILI <br /> A <br /> n 1 ^ <br /> ' 0 tic <br /> Q <br /> L - v <br /> A 7 <br /> Item/Location Temperature ( Item/Location Temperature <br /> rTemperatureI Warewashing <br /> Name: IndSi <br /> nk: of Chlorine: ppm ;Heat: of <br /> Exp.Date: rewashing Sink of Quat.Amm.: ppm iOther: of <br /> Received By/Title:/ v <br /> EH Specialist: r Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2^ pg) 4!3113 FOOD PROGRAM OR CONTINUATION <br />