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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• c4.. �'- (i Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.slgov.org/ehd <br />�l FO'f+N <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />M 9 Z ( Date: <br />Address: <br />City: <br />Zip Code: - <br />Owner/Operator: _ <br />Telephone: <br />Program Element: <br />Program Record: <br />Inspection Type: <br />SB180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />dCy 1 S <br />1 <br />T <br />l <br />�A T 3 g Z <br />tem o <br />Temperature: <br />,.�� S.i:rwi,= <br />Item / Location <br />- Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />of <br />Chlorine: ppm <br />Heat: of <br />11 <br />Exp. Date: <br />arewashing Sink: <br />-F <br />Cluat. Amm.: ppm <br />Other. eF <br />Received By I Title: It l� <br />\ <br />EH Specialist: <br />I <br />J <br />Time in: <br />Tim ut: , Page of <br />EHD 16-24 (20 pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />