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oPa"'"•. SAN JOAQUIN COUNTY <br /> r.' ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> N'a <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a o Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> �GIPii�N <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: ••ZAy zL <br /> Address: 1 f- city: � L /1s.Ze <br /> Zip Code: _ 6 <br /> Owner/Operator: r� 'l �' Q Telephone: Y <br /> Program Element: ,3 / Program Record: O 1:4 3 Inspection Type: <br /> 58180 Posted Ye No f7 Permit Posted Yels No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L 3 <br /> o <br /> i C <br /> !�P <br /> 24 <br /> i <br /> r <br /> vi y v\ I— <br /> � t h o ff <br /> yw/l W <br /> 1. <br /> 22 <br /> Item/Locatio Temperature _ _ Item f Temperature <br /> Food y •ertlficatio o Ilty Hot Water Temperature Warewflshin ,., <br /> Name: \ Hand Sink: 'F Chlorine: PPM Heat: 'F <br /> Exp.Dete• , arewashing Sink: �F Quat. Amm.: PPM Other: 'F <br /> Received By/Title: , <br /> EH Speclal[at: Phone: <br /> Ime In: Time Out: It b O Page of <br /> EHD 16-24 (2b pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />