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V <br /> • ao.P4H!Mn,,cAo SAN JOAQUIN COUNTY 9 ­t—o <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sioov.ora/ehd <br /> CI F d'e� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Data: '-�— 2 A _ <br /> ddress: .Zy W City:; Zip Code: <br /> Owner/Operator: \ a Telephone: `A0 y 3q g — <br /> Program Element: \�` Program Record: 5 3r ib Owl Inspection Type: g <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ul, <br /> e — 3. e -t - 3�- \ <br /> - L b, 1 � <br /> .3 = <br /> 2 r- <br /> _ - b <br /> 3 = w LI <br /> w c <br /> Zoq- b1 b - <br /> ,36 C5 Z <br /> Z2 <br /> ` 1 <br /> =Item/Locatio. _ -- - ItemlLocation-`I 'Temperature <br /> 2Cl0 <br /> Food Safety Certification ,_Facility,Hot Water Temperature Warewashing _ <br /> Name: Hand Sink: eF Chlorine: ppm Heat: <br /> Exp. Date: arew ning Slnk: �r aF Quat.Amm.: ppm Other: of <br /> Received By l Title: kNK�ST yr.��tn �,*Y,*Vr <br /> EH Specialist; <br /> Phone: (�\ <br /> Time In: \ , � c Time Out: Page of <br /> EHD 1624 (2n°pg) 413113 FOOD PROGRAM OR CONTINUATION <br />