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oPq�l" SAN JOAQUIN COUN <br /> �-•.�.coy <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> x <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> �q..• •.�;;p Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siQov.orq/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: (�_;2 q-/ <br /> Address: �(-)© -e-- City: Zip Code: % 5zo 7 <br /> Owner/Operator: 9"q' `52-_gY OQ Telephone: q74-743 <br /> Program Element: a `o Program Record: �7 R 0 2- Inspection Type: /fir <br /> SB180 Posted JW.Yes ❑ No Permit Posted XYes n No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r <br /> �C ,- d n� <br /> r.e <br /> 10 <br /> X <br /> Rk <br /> ' r 3 X 3 IC-- <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: aF Quat.Amm.: PPM Other: of <br /> Received By/Title: ' l 7 <br /> EH Specialist: Phon <br /> �J'S3- ?8 / <br /> Time in: Time Out: Page I of <br /> EHD 16-24 (211 pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />