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SAN JOAQUIN CO. .ry <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / Date: <br /> Address: AM-7- City: Zip Code: <br /> Owner/Operator: ✓ I. 6i L O Telephone: <br /> Program Element: 1. VProgram Record: O 15 3f 3 D Inspection Type: ,�0 <br /> 8180 Posted O Yes ❑ No Permit Posted ❑Yes ❑No a Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> F I✓�P ely ki N l R t I <br /> 3 v ?4-%,C s a <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> n <br /> - Food Safety Certification, _ Facility Hot Water Temperature Warewashing - <br /> Name: Gth u Z and Sink: L -F ,hlorine: PPM r <br /> eat: DF <br /> Exp.Date: N arewashing Sink: eF uat.Amm.: PPM they: ep <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: v I Time Out: Page Z <br /> EHD 16-24 (2"Pg) 4!9/12 FOOD PROGRAM CIS CONTINUATION <br />