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oPa"I"• SAN JOAQUIN COUNTY I <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 />�/FOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: '` <br />Date: b — <br />_ 'Z <br />Address: '?' U J c <br />2Q 1 City: <br />(% _ Zip Code: <br />Owner/Operator <br />}Z <br />Telephone: b.,so 181000 0-71 <br />Program Element: 11 _ <br />gram Record: S <br />Inspection Type: O <br />-1 <br />Sal SO Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />OWz�n l <br />'Ob <br />M <br />- b <br />`- Item Lfb ahon ` <br />Temperature- <br />-�_ <br />Item I Location <br />NEL'Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: k,211<3 <br />eF Chlorine: ppm <br />Heat: <br />of <br />Exp. Date: <br />arewashing Sink: t <br />eF rust Amm.: PPM <br />Other: <br />of <br />Received By / Title: <br />EH Specialist: <br />Phone: <br />`.r10� <br />Time in:,^ <br />Time Out:t 2 <br />P711 <br />EHD 16-24 (20 pg) 413113 <br />FOOD PROGRAM OIR CONTINUATION <br />S <br />