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""'" SAN JOAQUIN COUNTY <br />>o�, <br />?a ENVIRONMENTAL HEALTH DEPARTMENT <br />a: X <br />�_ _. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax. (209)464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: IL y!j <br />Address: <br />City: Zip Code: ¢SSS <br />44 <br />OwnerlOperator: <br />} Telephone: <br />Program Element:16 <br />9A Program Recor S o —b'C.I Inspection Type: <br />8180 Posted Yes <br />No Permit Posted Yes No Re -Inspection on or After: <br />'OBSEtiRVATIONS AND CORRECTIVE ACTIONS' <br />! <br />n Q <br />Pm I U <br />- <br />Item/Location Temperature <br />- Item l: Location: <br />(Temperature <br />I' Food•, Safety. Certification <br />- Facility Hot Water Temperature � WarewaAhing, - <br />Name: <br />Hand Sink: of Chlorine: PPM <br />Heat: OF <br />Exp. Date: <br />arewashing Sink: of Quat. Amm : ppm <br />ther: OF <br />Received By I Title: <br />' <br />Y <br />EH Specialist: <br />_ Phone: q ri,A _ b -,14 <br />, 1u-ZU <br />U 1 <br />Time in: <br />Time Out: Page\of <br />EHD16-24 (2n°pg) 413113 FOOD PROGRAM OR CONTINUATION <br />