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SAN JOAQUIN COUN <br /> Za ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4.. �;;P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: S Date: _ Ir— <br /> Address: 2 O ` City: A _ _ Zip Code: q S <br /> caner/Operator: 1 M� \ , _ W vT�Y1 Telephone: 22( _q4, <br /> Program Element: - Program Record: Inspection Type:B180 Posted ❑Yes ❑ Rermit Posted L,Yes ❑ I Re-Inspection on or After: <br /> a� M1 �. <br /> �, & OBSERVATIONS AND CORRECTIVE ACTIONS <br /> S n � 2 <br /> Sk A—( <br /> ( 1 <br /> ,5 - <br /> -I . �►. <br /> C . <br /> - - <br /> 3 <br /> Item/Location Temperature Item!Location Temperature <br /> i <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> W w. <br /> Name: _ Hand Slnk: 1 of Chlor in ^ ppm Heat: OF <br /> Exp.Date: W washing Sink: \ of Quat.Amm.: ppm Other: of <br /> Received By/Title--,'--" <br /> itle / 14==7777451 f r M -- <br /> EH Specialist G Phone: '4 0 <br /> Time in: " 1 S Time Out: 8� O Page of <br /> EHD 16-24 (2n0 pg) 413113 FOOD PROGRAM OR CONTINUATION <br />