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pP.A41 p SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: ­�) - i I - L <br /> Address: r•\ 1. City: c J 1 _ G�\_-/ Zip Code: Q 5 <br /> Owner/Operator: �je \ _ w '�, Telephone: <br /> Program Element: l Program Record: Inspection Type: 'Sic)- koeq-$I <br /> 8180 Posted Yes Na Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> C< <br /> \ON e r Serol ne co <br /> r,5 & <br /> It \ b O <br /> Item/Location Temperature Item/Location Temperature <br /> 2w <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name - ri <br /> _._ <br /> NaHand Sink: of Chlone: ppm Heat: =F <br /> Exp.D_ate Warewashing Sink: 'F dust.Amm.: PPM 11 Other: "F <br /> Received By/Title: V__13 S; CIQ p_ ` 1 <br /> EH Specialist• - V Phone: 2c)a�_ bi b - 3c):21 O'. 50 w�t1 <br /> Time in: �' ` Time Out: (i• 1 O a,-n Page\of I <br /> EHD 16-24 (2m pg)413'13 FOOD PROGRAM 018 CONTINUATION <br />