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,aP4 .�o SAN .JOAQUIN COUNTY <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4cIFa �P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sioov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: .� •d f'e� �(� Date: �Z <br /> ddress: ` City: Zip Code: <br /> Owner/Operator: GA04 a Telephone: <br /> Program Element: ,�L - Program Record: — ( I Inspection Type: <br /> 6180 Posted es No Permit Posted es No Re-inspection on or After: <br /> u OBSERVATIONS AND"CORRECTIVE ACTIONS <br /> CRY s <br /> c Un <br /> W¢l <br /> Item/Location j Temperature- Item./Cocatiud:. Temperature• <br /> ` Food;Safety Certification; Facility Hot Wafer Temperature Warewashingi. e <br /> Name: Hand Sink: lot, "F Chlorine: ppm Heat: 'F <br /> AL <br /> Exp.Date: ( L� arewashing Sink: - of Cluat.Amm.: PPM Other: of <br /> Received By I Title: `W t.:i <br /> B W�••i <br /> EH Specialist:• Phone:--WA <br /> , <br /> Time in: Time Out: Page of <br /> EHD1624 (2bpg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />