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�N JOAQUIN COUN�Y <br /> ENVI MENTAL HEALTH DEP TMENT <br /> 600 E. Main Street,Stockton,CA 95202-3029 <br /> ry Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> CO D <br /> Address: r�.x0 6 City: Zip de� <br /> Owner/Operator: Off✓ d I?A44�vt <br /> Program Element Code: //2 Program Record to: Ins 11 <br /> SB180 Posted as O No Permit Posted es n No Reinspection On or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> i <br /> Item/Location Temp. Item I location Temp.-- - Item I Location Temp. <br /> Food Safety Certification FacliftyHotWater Tomperat6re Warewashing u <br /> Name: Hand Sink: (� f 'F Chlorine: ppm JI <br /> Heat: •F <br /> Exp.Date: arewashing Sink: •F Quat.Amm. ppm Other: ppm <br /> ENVIRONMENTAL HEALTH AND SERVICE CHARGE FEES ARE AUTHORIZED BY RESOLUTION OF THE SAN JOAQUIN COUNTY BOARD OF SUPERVISORS. <br /> L DO UMENTED CRITICAL HEALTH VIOLATIONS OR REPEAT VIOLATIONS ARE SUBJECT TO A RENSPECTION AND REINSPECTION FEE. <br /> Received Bye Title: cnx+h1&-L– <br /> EH <br /> –LEH Specialist Phone: —1//_ – 3•7 <br /> LI <br /> Time In: O Time Out: �'((1 ((�sJJ D (J J <br /> r 1 o7s Page: of <br /> 19 <br /> F.HD/623(2ND PGI FOOD PROGRAM OR <br />