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���"'•y r SAN JOAQUIN COUNTY <br /> a: .< <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c•.. a Telephone: (209)468-3420 Fax. (209)464-0138 Web:www.siaov.oro/ehd <br /> 4Cl FBtYi'� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: -L Se ` $� City: Zip Code: 1510(0 <br /> Owner/Operator: �-U 11 tA �tti Telephone: <br /> Program Element: lo,.t'(P Prbgrarn Record: I;- C•t n Type:W- 1 Inspectio <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> - OBSERVATIONS AND`CORRECTIVE ACTIO.NS 1 T <br /> kyj I soWc <br /> �.. .._, _ _ _ <br /> lfem/Location, _ emperawn Iteml Locatiorn- - Temperature <br /> La <br /> - F.00d15afety.Certiflcation - Eacility'Hot Water Temperature - Vllarewashing' <br /> Name: Hand Sink: eF Chlorine: ppm Heat: of <br /> Exp.Date: Flarewashing Sink: eF Quat.Amm.: ppm 11 Other: of <br /> I <br /> eceived By/Title: <br /> H Specialist: N - — Phone: 9 ntc% 2i�7� <br /> ime in: Time Out: .3-1 Page ,Of <br /> EHD 1624 (2n°pg) 413113 FOOD PROGRAM 01R CONTINUATION <br />