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SAN JOAQUIN COUN <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.orQ/ehd <br /> �fFO� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: d <br /> Date: /.J-- JZ <br /> Address: I S SS O tL+ S City. u Zip Code: <br /> Owner/Operator: Telephone: <br /> U rarer �i � �� <br /> Program Element: Program Record: /� Inspection Type: <br /> I 0:zSIC OQ1GJr� r1I CGnSuI4G4ipr *t•irW <br /> S6180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS� <br /> a jW p I t r Of 0 a <br /> k - Q b cv 4o <br /> 300 <br /> Gir 40 <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing•.. <br /> Name: I I u„ Hand Sink: of Chlorine: ppm Heat: of <br /> /CL <br /> Exp.Date: G arewashing Sink: / of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: ; Time out: Page`of <br /> EHD 16-24 (21'pg) 419/12 FOOD PROGRAM OIR CONTINUATION <br />