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1L_ <br /> �oPq .coG SAN jOAQUIN COON IY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:vvww.sjgov.orq/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / ''S 1,u a h", Date: ZS-7,17-V <br /> 2 - <br /> Address: 3 i City: Zip Code: <br /> Owner/Operator: r'� e. �fQ Z OkiTelephone: <br /> Program Element: j'PProgram Record: �n /� �i�i' Inspection Type:� k l��/fir <br /> Vil-80—posted Yes No Permit Posted Yes No ✓ v Re-inspection on or After: /"N <br /> _ OBSERVATIONS AND CORRECTIVE ACTIONS "' r f „ <br /> C 44 62 <br /> y0,0 <br /> t cal4dff all dY G Get <br /> L i� <br /> t n D.1 V,` 2t> <br /> - - - . <br /> n1imlL'ocatiom <br /> Terriperature Item/Cocationr- ? it.6 nature <br /> l` Foodty C <br /> _;Safeertification' li4y <br /> FaciHot Water Temperature ' n.. L �� Warewas_ng; <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: OF <br /> uat.Amm.: ppm Other: OF <br /> Received By/Title: <br /> EH Specialist: Phone: 1„�� z <br /> Time in: 91 121 2 Time Out: its ✓ PageVf7 <br /> EHD 16-24 (2ntl pg) 4!3113 FOOD PROGRAM OIR CONTINUATION <br />