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,oP4 .ro� SAN JOAQUIN COUNTY <br /> P' y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sioov.oro/ehd <br /> GI FdRN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Affxx, qtc� Date: (Z Z Z0 <br /> Address: 7 City: Zip Code: 82�o q <br /> Owner/Operator: 1 —0.fCr_b_r0 Telephone: <br /> Program Element: `.� CW\ Program Record: Inspection Type: <br /> SB180 Posted Ye No Permit Posted a No Re-Inspection on or After: <br /> _. ,_. <br /> _ . . .,� <br /> OBSERVATIONS`AND'CORRECTIVE ACTIONS' <br /> sA <br /> lltnKA8=4c�� V\0 4' , ! <br /> __- Item/Locatioir Temperature - Item CLocatiom 'Temperature <br /> _ F.,00d Safety.Certific_ahon. ___ _ Facility.Hot Water Temperature ` W_arewasti_ng _ <br /> Name: Hand Sink: ,F hlorine: Ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: Ppm Other: ,F <br /> Received By I Title: Prje <br /> d <br /> EH Specialist: Phone: 60"A— G _2�l-tea <br /> ime in: Time Out: l J'1W Page of <br /> EHD16-24 (2n0pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />